Individual
SHA'SHONDA LA'TRELL REVELS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
200 UCLA MEDICAL PLZ STE B265, LOS ANGELES, CA 90095-8358
(310) 794-7333
(310) 794-7335
Mailing address
5767 W CENTURY BLVD STE 400, LOS ANGELES, CA 90045-5631
Taxonomy
Speciality
Code
Description
License number
State
2086S0102X
Surgical Critical Care Physician
A140738
CA
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
A140738
CA
Other
Enumeration date
06/25/2008
Last updated
01/17/2020
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