# REVELATION FAMILY MEDICINE OFFICE, LLC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912472200
- **Authorized official:** MR. JEAN-MARCEL FORTE PA-C (CERTIFIED PHYSICIAN ASSISTANT)
- **Authorized official phone:** (305) 807-4283

## Contact information

- **Practice address:** 3939 HOLLYWOOD BLVD STE 300B, HOLLYWOOD, FL 33021-6749
- **Practice address phone:** (786) 863-8633
- **Mailing address:** 3939 HOLLYWOOD BLVD STE 300B, HOLLYWOOD, FL 33021-6749
- **Mailing address phone:** (786) 863-8633

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0505X | Adult Medicine Physician | — | NULL | Yes |
| 207QA0505X | Adult Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/12/2018
- **Last updated:** 10/12/2018