OrganizationActive
Core Revive / Soul Revive LLC
NPI 1154826980 · Nutrition Support Registered Nurse · Petaluma, CA
Provider details
- NPI number
- 1154826980
- Entity type
- Organization
- Primary specialty
- Nutrition Support Registered NurseNursing Service Providers
- Authorized official
- Philip Diehl, Partner
- License
- 846331 (CA)
Mailing address
16 Queens Ln
Petaluma, CA 94952-1047
Registry dates
- Enumerated
- 2018-03-26
- Last updated
- 2019-06-11
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.