REVIVE INJECTION CLINIC – NPI #1104784297
Clinic/Center

An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).

Health Care Provider Taxonomy Code for Clinic/Center

REVIVE INJECTION CLINIC is an AHC clinic located in VALENCIA, CA. NPPES has assigned the NPI number 1104784297 to REVIVE INJECTION CLINIC on January 15, 2026. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The primary taxonomy selected by this provider is 261QM2500X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Medical Specialty

Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for REVIVE INJECTION CLINIC below.

NPI Profile for
REVIVE INJECTION CLINIC

NPI Number
1104784297
Enumeration Date

(about 5 months ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
REVIVE INJECTION CLINIC
Primary location
27833 AVENUE HOPKINS STE 6
VALENCIA, CA 91355-4562
Phone: (661) 407-8507 Fax:
Mailing address
28207 TANGERINE LN
SANTA CLARITA, CA 91350-3257
Phone: (818) 536-8165 Fax: (818) 536-8165
Organization Subpart
No
Authorized Official
JENNA GOODWIN
CO-OWNER
Phone: (818) 536-8165
Updated
Certification Date
Jan 15, 2026

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QM2500X
- Clinic/Center / Medical Specialty (Primary)

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.