Revivify Restorative Medicine - Medicare Primary Care in San Diego, CA

Revivify Restorative Medicine is a medicare enrolled primary clinic (Family Medicine - Sports Medicine) in San Diego, California. The current practice location for Revivify Restorative Medicine is 16445 Bernardo Center Dr, San Diego, California. For appointments, you can reach them via phone at (858) 429-0099. The mailing address for Revivify Restorative Medicine is 16445 Bernardo Center Dr, San Diego, California and phone number is (858) 429-0099.

Revivify Restorative Medicine is licensed to practice in California (license number 20A8442). The clinic also participates in the medicare program and its NPI number is 1003164385. This medical practice accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at (858) 429-0099.

Contact Information

Revivify Restorative Medicine
16445 Bernardo Center Dr
San Diego
CA 92128-2523
(858) 429-0099
(858) 676-1172

Primary Care Clinic Profile

Full NameRevivify Restorative Medicine
SpecialityFamily Medicine
Location16445 Bernardo Center Dr, San Diego, California
Authorized Official Name and PositionStephen M Daquino (MEDICAL DIRECTOR)
Authorized Official Contact8584290099
Accepts Medicare InsuranceYes. This clinic participates in medicare program and accept medicare insurance.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Revivify Restorative Medicine
16445 Bernardo Center Dr
San Diego
CA 92128-2523

Ph: (858) 429-0099
Revivify Restorative Medicine
16445 Bernardo Center Dr
San Diego
CA 92128-2523

Ph: (858) 429-0099

NPI Details:

NPI Number1003164385
Provider Enumeration Date08/17/2012
Last Update Date07/29/2020

Medicare PECOS Information:

Medicare PECOS PAC ID7416107149
Medicare Enrollment IDO20121015000655

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Medical Identifiers

Medical identifiers for Revivify Restorative Medicine such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1003164385NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
207QS0010XFamily Medicine - Sports Medicine 20A8442 (California)Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Revivify Restorative Medicine acts as a billing entity for following providers:
Provider NameStephen M Daquino
Provider TypePractitioner - Osteopathic Manipulative Medicine
Provider IdentifiersNPI Number: 1346351665
PECOS PAC ID: 8325009582
Enrollment ID: I20041020001345

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