# REVIVEX HEALTHCARE INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Pacific Pain & Wellness Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083087613
- **Authorized official:** KARTIK ANANTH (OWNER)
- **Authorized official phone:** (310) 437-7399

## Contact information

- **Practice address:** 23150 CRENSHAW BLVD STE 100, TORRANCE, CA 90505-3025
- **Practice address phone:** (310) 437-7399
- **Practice address fax:** (888) 431-8819
- **Mailing address:** 23150 CRENSHAW BLVD STE 100, TORRANCE, CA 90505-3025
- **Mailing address phone:** (104) 377-3993
- **Mailing address fax:** (210) 437-7398

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | A109016 | NULL | Yes |

## Other

- **Enumeration date:** 11/04/2015
- **Last updated:** 03/22/2024