Organization
RODOLFO M. REVILLA, MDPA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RODOLFO MANUEL REVILLA M.D. (PRESIDENT)
(915) 532-9100
Entity
Organization
Contact information
Practice address
1600 MEDICAL CENTER DR STE 309, EL PASO, TX 79902-5008
(915) 532-9100
(915) 532-9652
Mailing address
1600 MEDICAL CENTER DR STE 309, EL PASO, TX 79902-5008
(915) 532-9100
(915) 532-9652
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
160023417
RAIL ROAD PTAN #
TX
05
—
203168401
—
TX
01
—
F36830
UPIN
TX
Enumeration date
03/03/2009
Last updated
09/28/2010
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