Individual
JOSE FELIX REVOLLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
703 CLAMOR CT, FORT WASHINGTON, MD 20744-5170
(201) 757-4005
Mailing address
703 CLAMOR CT, FORT WASHINGTON, MD 20744-5170
(201) 757-4005
Taxonomy
Speciality
Code
Description
License number
State
163WR0400X
Rehabilitation Registered Nurse
Primary
RN1039386
DC
Other
Enumeration date
11/20/2019
Last updated
11/20/2019
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