Organization
REVIVIFY DERMATOLOGY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENISE M. GUEVARA DO (MEDICAL DIRECTOR)
(561) 877-8675
Entity
Organization
Contact information
Practice address
21301 POWERLINE RD # 108, BOCA RATON, FL 33433-2388
(561) 877-8675
(561) 672-1365
Mailing address
21301 POWERLINE RD STE 108, BOCA RATON, FL 33433-2388
(561) 877-8675
(561) 672-1365
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
10/30/2019
Last updated
08/19/2020
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