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Organization

REVIVE REJUVENATION CENTER ANTI AGING REGENERATIVE CENTER INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MICHELLE GUTIERREZ (CREDENTIALING SPECIALIST)
(619) 501-6278
Entity
Organization

Contact information

Practice address
7509 DRAPER AVE STE A, LA JOLLA, CA 92037-4857
(858) 352-6200
(858) 362-7555
Mailing address
7509 DRAPER AVE, LA JOLLA, CA 92037-4862
(858) 352-6200
(858) 362-7555

Taxonomy

Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary

Other

Enumeration date
03/01/2018
Last updated
03/21/2018
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