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Organization
VIDA REVIVAL LLC
Active
Organization
VIDA REVIVAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANA ALAVI (OWNER)
(818) 232-8432
Entity
Organization
Contact information
Practice address
3180 WILLOW LN STE 114, THOUSAND OAKS, CA 91361-4984
(818) 232-8432
(818) 232-8433
Mailing address
3180 WILLOW LN STE 114, THOUSAND OAKS, CA 91361-4984
(818) 232-8432
(818) 232-8433
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
02/06/2025
Last updated
02/06/2025
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