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Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Adult Medicine |
207QA0505X | 08 | Physician/Family Practice |
| NPI Number | 1790653533 |
| LBN Legal business name | REVIVAL WELLNESS LLC |
| Authorized official | NATHAN MALEK - (CEO) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 10/24/2025 |
| Last updated | 10/24/2025 - About 7 months ago |
| Identifiers | n/a |
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REVIVAL WELLNESS LLC
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REVIVAL WELLNESS LLC