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VIDA REVIVAL LLC
NPI 1952115149
Internal Medicine in Thousand Oaks, CA

Active since February 06, 2025CLIA 05D2335030 · Waiver
3180 WILLOW LN STE 114, THOUSAND OAKS, CA 91361(818) 232-8432(818) 232-8433 Get Directions Write a Review

NPPES record last updated: February 6, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Vida Revival Llc NPPES

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

VIDA REVIVAL LLC (NPI 1952115149) is a healthcare organization registered as an internal medicine in Thousand Oaks, California and active in the NPI registry since February 2025. The organization holds a CLIA Waiver certificate valid through December 3, 2027 and lists Diana Alavi, Owner, as its authorized official.

NPPES Registry Identity

NPI1952115149
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameVIDA REVIVAL LLC
Location Address3180 WILLOW LN STE 114Thousand Oaks, CA 91361-4984
Mailing Address3180 Willow Ln Ste 114Thousand Oaks, CA 91361-4984 · (818) 232-8432 · Fax (818) 232-8433
Phone(818) 232-8432
Fax(818) 232-8433
Organization SubpartNo
Authorized OfficialDiana AlaviOwner · (818) 232-8432
Enumeration DateFebruary 6, 2025
NPPES CertifiedFebruary 6, 2025
✔ NPI 1952115149 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
3180 WILLOW LN STE 114, Thousand Oaks, CA 91361
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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 SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D2335030

Vida Revival Mc · Thousand Oaks, CA
Active · expires Dec 3, 2027
CLIA Number05D2335030
Laboratory TypePhysician Office
Certificate Effective DateDecember 4, 2025
Certificate Expiration DateDecember 3, 2027
Laboratory DirectorAlavi Diana
Laboratory Phone(917) 528-0527
Laboratory LocationVida Revival Mc3180 Willow Ln, Ste 114, Thousand Oaks, CA 91361
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. PONTEA HARIRI DACCHM, L.AC.
Acupuncturist
3180 WILLOW LN STE 114
THOUSAND OAKS, CA 91361
Los Angeles County (818) 232-8432
HOWELL HEALTHCARE
Clinic/Center (Urgent Care)
3180 WILLOW LN STE 114
THOUSAND OAKS, CA 91361
Los Angeles County (805) 373-1785
DIANA ALAVI
Internal Medicine
3180 WILLOW LN STE 114
THOUSAND OAKS, CA 91361
Los Angeles County (818) 232-8432
VIDA REVIVAL MEDICAL CORPORATION
Clinic/Center (Primary Care)
3180 WILLOW LN STE 114
THOUSAND OAKS, CA 91361
Los Angeles County (818) 232-8432

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 Vida Revival LLC's NPI number?

The NPI number for Vida Revival LLC is 1952115149. It was assigned to this organization in the NPPES registry on February 6, 2025.

Where is Vida Revival LLC located?

Vida Revival LLC is located at 3180 Willow Ln Ste 114, Thousand Oaks, CA 91361. The listed phone number is (818) 232-8432.

What is Vida Revival LLC's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Does Vida Revival LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D2335030) is associated with this NPI, valid through December 3, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Vida Revival LLC was last updated on February 6, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.