Organization
REVITAL MEDICAL HEALTH GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PIERRE A. GASTON M.D. (PRESIDENT)
(305) 949-4964
Entity
Organization
Contact information
Practice address
17064 W DIXIE HWY, N MIAMI BEACH, FL 33160-3723
(305) 949-4964
(305) 948-6519
Mailing address
17064 W DIXIE HWY, NORTH MIAMI BEACH, FL 33160-3723
(305) 949-4964
(305) 948-6519
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
ME 41852
FL
Other
Enumeration date
07/28/2010
Last updated
09/11/2013
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