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Organization
REVITALIZE LIFE CENTER A PC
Active
Organization
REVITALIZE LIFE CENTER A PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EBONY D FOSTER (BILLING SUPPORT)
(562) 457-6010
Entity
Organization
Contact information
Practice address
3939 ATLANTIC AVE STE 100, LONG BEACH, CA 90807-3529
(562) 457-6010
(562) 424-5600
Mailing address
3939 ATLANTIC AVE STE 100, LONG BEACH, CA 90807-3529
(562) 457-6010
(562) 424-5600
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
04/06/2020
Last updated
04/06/2020
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