Provider Demographics
NPI:1285102525
Name:REVIVE ANESTHESIA INC
Entity type:Organization
Organization Name:REVIVE ANESTHESIA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MANO
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANAA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-854-6427
Mailing Address - Street 1:20315 VENTURA BLVD STE 315A
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2449
Mailing Address - Country:US
Mailing Address - Phone:818-854-6427
Mailing Address - Fax:818-854-6428
Practice Address - Street 1:20315 VENTURA BLVD STE 315A
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2449
Practice Address - Country:US
Practice Address - Phone:818-854-6427
Practice Address - Fax:818-854-6428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-05
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty