Revive.Md
ActiveCalifornia license 556603
License
- Licensed by
- Medical Board of California
- License number
- 556603
- Status
- Active (Current)
- First issued
- October 26, 2023
- Expires
- October 31, 2027
- Entity type
- Organization
Classifications
- Fictitious Name Permit Physicians & Surgeons
More from the license record
- License type code
- 8008
Contact
711 4th Ave Ste 200
San Diego, CA 92101-6863
San Diego, CA 92101-6863
San Diego County