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Organization
REVIVA WOUND CARE SPECIALISTS
Active
Organization
REVIVA WOUND CARE SPECIALISTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SIEGHART PONHOLD MD (CEO)
(657) 444-1233
Entity
Organization
Contact information
Practice address
701 W KIMBERLY AVE STE 270, PLACENTIA, CA 92870-6342
(657) 444-1233
Mailing address
701 W KIMBERLY AVE STE 270, PLACENTIA, CA 92870-6342
(657) 444-1233
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
05/22/2025
Last updated
05/22/2025
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