Organization
REVIVE IV HYDRATION THERAPY
Active
Other names
HYDRA the hydration spa
Organization subpart
No
Provider details
NPI number
Authorized official
SAMAH MOHAMED M.S (OWNER)
(720) 935-1490
Entity
Organization
Contact information
Practice address
4747 E ELLIOT RD # 109, PHOENIX, AZ 85044-1627
(480) 876-1148
Mailing address
4747 E ELLIOT RD # 109, PHOENIX, AZ 85044-1627
(480) 876-1148
Taxonomy
Speciality
Code
Description
License number
State
261QI0500X
Infusion Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
02/16/2023
Last updated
02/16/2023
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