Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Revive Medical Group Ca PC

Organization Psychiatry Physician · NPI 1518724624

Revive Medical Group Ca PC is a Psychiatry Physician in Mount Shasta, California. Registered with an NPI since 2024.

In the registry since
2024
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

914 Pine St
Mount Shasta, CA 96067-2143
Phone: (203) 430-1321
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatry Physician (primary) Taxonomy 2084P0800X

Record details

NPI number1518724624
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Omar Ziyadeh — Ceo/Manager · (203) 430-1321
NPI enumeratedMarch 5, 2024
Last updated in NPPESMarch 5, 2024
Certification dateMarch 5, 2024
Mailing address81 Roanoke Ave, Fairfield, CT 06824-6124

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