REVIVE SALON AND SPA (NPI# 1619415072) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619415072 |
| Entity Type | Organization |
| Organization Name | REVIVE SALON AND SPA |
| Practice Address |
5965 Village Way E207 San Diego CA 92130-2475 |
| Mailing Address |
4328 Mount Hukee Ave San Diego CA 92117-4738 |
| Practice Telephone | 6192937233 |
| Mailing Telephone | 7045166782 |
| Enumeration Date | 2017-02-06 |
| Last Update Date | 2017-02-06 |
| Authorized Official Name | MARY LYNN ELIZABETH EICHERT (NURSE PRACTITIONER) |
| Authorized Official Telephone | 7045166782 |
| Authorized Official Credential | NP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
95005931 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
5965 VILLAGE WAY E207 |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92130-2475 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639566565 | John C. Nosti, D.d.s. Inc. | Dentist | 5965 Village Way, Suite E-206, San Diego, CA 92130 | 2015-04-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629692397 | Tlc Family Therapy | Marriage & Family Therapist | 5965 Village Way. Suite 105 #112, San Diego, CA 92130 | 2020-05-29 |
| 1447746169 | Jack Perlov | Psychiatry & Neurology | 3535 Caminito El Rincon, Unit 268, San Diego, CA 92130 | 2018-07-05 |
| 1326551003 | Theotokos, LLC | Pharmacy | 5550 Carmel Mountain Rd Ste 111, San Diego, CA 92130 | 2017-11-16 |
| 1154879146 | Halie Hommes | Occupational Therapist | 12250 El Camino Real Ste 250, San Diego, CA 92130 | 2016-09-19 |
| 1790232015 | Coastal Skin and Eye Institute, Inc. | Ophthalmology | 5550 Carmel Mountain Road, Suite 206, San Diego, CA 92130 | 2016-09-02 |
| 1720534951 | Nosti and Rygg Dental Corporation | Dentist | 5550 Carmel Mountain Road, Ste 200, San Diego, CA 92130 | 2016-08-28 |
| 1831644053 | Marco Savittieri | Dentist | 3715 Ruette De Vl, San Diego, CA 92130 | 2016-08-17 |
| 1336508621 | Discovery Practice Management, Inc | Psychiatric Residential Treatment Facility | 11455 Camino Real, Ste 360, San Diego, CA 92130 | 2016-02-16 |
| 1427434679 | Coast Pediatrics Carmel Valley | Pediatrics | 5965 Village Drive, Suite 201, San Diego, CA 92130 | 2015-08-10 |
| 1659753762 | T Sidal Dds Md Inc | Dentist | 12395 El Camino Real, Suite 304, Torrey Pines Oral & Maxillofacial Surgery, San Diego, CA 92130 | 2015-06-25 |
| Find all providers in zip 92130 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982203097 | Rebecca Dolores Garcia | Nurse Practitioner | 2440 Curlew St, San Diego, CA 92101-1327 | 2020-10-20 |
| 1003415472 | Ryanleo Flores | Nurse Practitioner | 2017 1st Avenue, Suite 301, San Diego, CA 92101 | 2020-10-18 |
| 1083226245 | Allison Floyd | Nurse Practitioner | 3652 Texas St, San Diego, CA 92104-4044 | 2020-08-19 |
| 1386255248 | Helen Hyeyoung Hong | Nurse Practitioner | 5140 Caminito Exquisito, San Diego, CA 92130-2852 | 2020-08-13 |
| 1134747595 | Dawn Elyse Rose | Nurse Practitioner | 8260 Mira Mesa Blvd Ste A, San Diego, CA 92126-2662 | 2020-07-10 |
| 1982232591 | John Meier | Nurse Practitioner | 3745 Riviera Dr Apt 10, San Diego, CA 92109-6661 | 2020-03-30 |
| 1013543008 | Alex Choi Mara | Nurse Practitioner | 5248 Zephyr Ln Unit 24, San Diego, CA 92120-2749 | 2020-03-21 |
| 1669005021 | Katlyn Ann Hartman | Nurse Practitioner | 1951 4th Ave, San Diego, CA 92101-2374 | 2020-02-13 |
| 1245876101 | Katherine Baber | Nurse Practitioner | 3671 Fifth Ave, San Diego, CA 92103-4218 | 2019-11-25 |
| 1922644095 | Taiko Harris | Nurse Practitioner | 13592 Bolero Way, San Diego, CA 92130-7006 | 2019-11-22 |
| Find all providers in SAN DIEGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.