# REVITAL MEDICAL HEALTH GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679887053
- **Authorized official:** DR. PIERRE A. GASTON M.D. (PRESIDENT)
- **Authorized official phone:** (305) 949-4964

## Contact information

- **Practice address:** 17064 W DIXIE HWY, N MIAMI BEACH, FL 33160-3723
- **Practice address phone:** (305) 949-4964
- **Practice address fax:** (305) 948-6519
- **Mailing address:** 17064 W DIXIE HWY, NORTH MIAMI BEACH, FL 33160-3723
- **Mailing address phone:** (305) 949-4964
- **Mailing address fax:** (305) 948-6519

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | ME 41852 | FL | Yes |

## Other

- **Enumeration date:** 07/28/2010
- **Last updated:** 09/11/2013