# REVITALIS LLC

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

## Provider details

- **NPI number:** 1710788294
- **Authorized official:** NATHAN JOWETT MD, PHD (DIRECTOR)
- **Authorized official phone:** (480) 520-3223

## Contact information

- **Practice address:** 7600 E CAMELBACK RD STE 7, SCOTTSDALE, AZ 85251-2106
- **Practice address phone:** (480) 520-3223
- **Practice address fax:** (480) 847-3223
- **Mailing address:** 7600 E CAMELBACK RD STE 7, SCOTTSDALE, AZ 85251-2106
- **Mailing address phone:** (480) 520-3223
- **Mailing address fax:** (480) 847-3223

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207YS0123X | Facial Plastic Surgery Physician | — | NULL | — |
| 207YS0123X | Facial Plastic Surgery Physician | — | — | — |
| 207YX0007X | Plastic Surgery within the Head & Neck (Otolaryngology) Physician | — | NULL | Yes |
| 207YX0007X | Plastic Surgery within the Head & Neck (Otolaryngology) Physician | — | — | Yes |
| 207YX0905X | Otolaryngology/Facial Plastic Surgery Physician | — | NULL | — |
| 207YX0905X | Otolaryngology/Facial Plastic Surgery Physician | — | — | — |

## Other

- **Enumeration date:** 03/21/2025
- **Last updated:** 05/20/2026