# REVIVE WELLNESS CENTER

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

## Provider details

- **NPI number:** 1013372242
- **Authorized official:** SHONDA CHASE FNP (OWNER)
- **Authorized official phone:** (310) 375-7599

## Contact information

- **Practice address:** 22330 HAWTHORNE BLVD, SUITE J, TORRANCE, CA 90505-2536
- **Practice address phone:** (310) 375-7599
- **Practice address fax:** (310) 414-0777
- **Mailing address:** 22330 HAWTHORNE BLVD, SUITE J, TORRANCE, CA 90505-2536
- **Mailing address phone:** (310) 375-7599
- **Mailing address fax:** (310) 414-0777

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 95003531 | CA | Yes |

## Other

- **Enumeration date:** 12/14/2015
- **Last updated:** 12/14/2015