Provider Demographics
NPI:1730542259
Name:REVUPMD
Entity type:Organization
Organization Name:REVUPMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-384-3904
Mailing Address - Street 1:17915 ERWIN ST
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-7109
Mailing Address - Country:US
Mailing Address - Phone:818-384-3904
Mailing Address - Fax:
Practice Address - Street 1:17915 ERWIN ST
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-7109
Practice Address - Country:US
Practice Address - Phone:818-384-3904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-01
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment