Organization
REVIVEX HEALTHCARE INC
Active
Other names
Pacific Pain & Wellness Group
Organization subpart
No
Provider details
NPI number
Authorized official
KARTIK ANANTH (OWNER)
(310) 437-7399
Entity
Organization
Contact information
Practice address
23150 CRENSHAW BLVD STE 100, TORRANCE, CA 90505-3025
(310) 437-7399
(888) 431-8819
Mailing address
23150 CRENSHAW BLVD STE 100, TORRANCE, CA 90505-3025
(104) 377-3993
(210) 437-7398
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
A109016
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2155100
PK
—
Enumeration date
11/04/2015
Last updated
03/22/2024
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