Revital Medical Health Group LLC
NPI #1679887053 in N Miami Beach, Florida
Provider Information
- NPI Number
- 1679887053
- Entity Type
- Organization
- Organization Name
- Revital Medical Health Group LLC
- Primary Specialty
- General Practice
- Enumeration Date
- Jul 28, 2010
- Last Updated
- Sep 11, 2013
Practice Location
- Address
- 17064 W DIXIE HWY
- City
- N Miami Beach
- State
- Florida
- ZIP Code
- 33160-3723
- Phone
- (305) 949-4964
Authorized Official
- Name
- DR. PIERRE A. GASTON, M.D.
- Title
- PRESIDENT
- Phone
- (305) 949-4964
Specialties & Taxonomy Codes
| Specialty |
|---|
| General Practice |
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