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Organization
REVIVAL DME CORP
Active
Organization
REVIVAL DME CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM GOWDY JEFFERSON (PRESIDENT)
(951) 490-3751
Entity
Organization
Contact information
Practice address
4025 CAMINO DEL RIO S STE 300, SAN DIEGO, CA 92108-4108
(619) 542-7738
Mailing address
4025 CAMINO DEL RIO S STE 300, SAN DIEGO, CA 92108-4108
(619) 542-7738
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
NULL
Other
Enumeration date
10/27/2018
Last updated
10/27/2018
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