Organization
REVITAL MEDICAL HEALTH GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MILY HERNANDEZ (MANAGER)
(305) 748-9310
Entity
Organization
Contact information
Practice address
17064 W DIXIE HWY, NORTH MIAMI BEACH, FL 33160-3723
(305) 949-4964
Mailing address
17064 W DIXIE HWY, NORTH MIAMI BEACH, FL 33160-3723
(305) 949-4964
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
09/03/2013
Last updated
09/03/2013
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