Individual
BRADFIELD REVELO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7128 VIGO AVE SW, ALBUQUERQUE, NM 87121-5460
(505) 274-5170
Mailing address
7128 VIGO AVE SW, ALBUQUERQUE, NM 87121-5460
(505) 274-5170
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R56456
NM
225100000X
Physical Therapist
Primary
4548
NM
Other
Enumeration date
07/14/2015
Last updated
12/26/2024
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