# REVITALIZE WELLNESS CENTER INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003637448
- **Authorized official:** SHAZIA TABASUM MALIK (NP)
- **Authorized official phone:** (559) 507-3760

## Contact information

- **Practice address:** 2501 W SHAW AVE STE 113, FRESNO, CA 93711-3307
- **Practice address phone:** (559) 507-3760
- **Practice address fax:** (539) 238-2199
- **Mailing address:** 5170 N FLOYD AVE, FRESNO, CA 93723-9435
- **Mailing address phone:** (559) 507-3760
- **Mailing address fax:** (539) 238-2199

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 10/18/2024
- **Last updated:** 04/14/2026