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Organization
REVITAWOUND INCORPORATED
Active
Organization
REVITAWOUND INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER MATA (OWNER)
(562) 506-6577
Entity
Organization
Contact information
Practice address
146 N SAN FERNANDO BLVD STE 213, BURBANK, CA 91502-1230
(562) 506-6577
(747) 877-8189
Mailing address
146 N SAN FERNANDO BLVD STE 213, BURBANK, CA 91502-1230
(562) 506-6577
(747) 877-8189
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
11/07/2024
Last updated
11/19/2024
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