Organization
REVIVE MEDICAL SUPPLIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CORY JACOBSEN MBA (CEO)
(949) 390-9105
Entity
Organization
Contact information
Practice address
1617 S BURLINGTON AVE, LOS ANGELES, CA 90006-2567
(949) 390-9105
Mailing address
PO BOX 811457, LOS ANGELES, CA 90081-0008
(949) 390-9105
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
05/05/2020
Last updated
01/04/2023
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