Provider Demographics
NPI:1962154880
Name:RAVIVE HEALTH & VITALITY LLC
Entity type:Organization
Organization Name:RAVIVE HEALTH & VITALITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:FLAMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-520-1285
Mailing Address - Street 1:2907 SHELTER ISLAND DR STE 219
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-2744
Mailing Address - Country:US
Mailing Address - Phone:619-642-0477
Mailing Address - Fax:
Practice Address - Street 1:2907 SHELTER ISLAND DR STE 219
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-2744
Practice Address - Country:US
Practice Address - Phone:619-642-0477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty