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Organization
REVIVE WELLNESS CENTER
Active
Organization
REVIVE WELLNESS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHONDA CHASE FNP (OWNER)
(310) 375-7599
Entity
Organization
Contact information
Practice address
22330 HAWTHORNE BLVD, SUITE J, TORRANCE, CA 90505-2536
(310) 375-7599
(310) 414-0777
Mailing address
22330 HAWTHORNE BLVD, SUITE J, TORRANCE, CA 90505-2536
(310) 375-7599
(310) 414-0777
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
95003531
CA
Other
Enumeration date
12/14/2015
Last updated
12/14/2015
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