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CORE REVIVE
NPI 1154826980
Registered Nurse - Nutrition Support in Petaluma, CA

Active since March 26, 2018
16 QUEENS LN, PETALUMA, CA 94952(707) 559-5347 Get Directions Write a Review

NPPES record last updated: June 11, 2019. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Jun 11, 2019, Jun 16, 2018, Mar 26, 2018 (3 updates tracked since 2018).

About Core Revive NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CORE REVIVE (NPI 1154826980) is a healthcare organization registered as a nutrition support in Petaluma, California and active in the NPI registry since March 2018. The organization lists Philip Anthony Diehl, Partner, as its authorized official.

NPPES Registry Identity

NPI1154826980
Entity TypeOrganization
Primary Taxonomy163WN1003X
Legal Business NameCORE REVIVE / SOUL REVIVE LLC
Location Address16 QUEENS LNPetaluma, CA 94952-1047
Mailing Address16 Queens LnPetaluma, CA 94952-1047 · (707) 559-5347
Phone(707) 559-5347
Organization SubpartNo
Authorized OfficialPhilip Anthony DiehlPartner · (415) 250-7118
Enumeration DateMarch 26, 2018
Last NPPES UpdateJune 11, 20193 updates tracked since enumeration
✔ NPI 1154826980 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyRegistered Nurse · Nutrition SupportNursing Service Providers
Taxonomy Code163WN1003X
License✔ Licensed in CA · 846331
Also ListedRegistered Nurse · Diabetes EducatorTaxonomy 163WD0400X · License 846331 (CA)
16 QUEENS LN, Petaluma, CA 94952
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Other Names 1

Doing Business AsCore Revive

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Core Revive / Soul Revive LLC's NPI number?

The NPI number for Core Revive / Soul Revive LLC is 1154826980. It was assigned to this organization in the NPPES registry on March 26, 2018.

Where is Core Revive / Soul Revive LLC located?

Core Revive / Soul Revive LLC is located at 16 Queens Ln, Petaluma, CA 94952. The listed phone number is (707) 559-5347.

What is Core Revive / Soul Revive LLC's specialty?

The primary specialty registered for this NPI is Registered Nurse, specializing in Nutrition Support, with taxonomy code 163WN1003X.

When was this NPI record last updated?

The NPPES record for Core Revive / Soul Revive LLC was last updated on June 11, 2019. NPI Profile syncs with the weekly NPPES data releases published by CMS.