Provider Demographics
NPI:1841980521
Name:REVIVE WOUND CARE CENTER INC.
Entity type:Organization
Organization Name:REVIVE WOUND CARE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:AZIZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-409-9059
Mailing Address - Street 1:8218 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BELL GARDENS
Mailing Address - State:CA
Mailing Address - Zip Code:90201-6212
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:310-943-3150
Practice Address - Street 1:7021 SEVILLE AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-4903
Practice Address - Country:US
Practice Address - Phone:833-736-3988
Practice Address - Fax:310-943-3150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Single Specialty