Individual
DIANA REVENCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6919 N DALE MABRY HWY STE 125, TAMPA, FL 33614-3972
(813) 497-9661
(813) 615-8468
Mailing address
1100 9TH AVE, MS:M4-PFS, SEATTLE, WA 98101-2756
(206) 515-5811
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
MD60668587
WA
207RC0000X
Cardiovascular Disease Physician
Primary
ME146373
FL
207UN0901X
Nuclear Cardiology Physician
15634
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1386810091
—
ME
05
—
3075998
—
NH
01
—
P01138997
RR MEDICARE
NH
Enumeration date
05/02/2008
Last updated
09/15/2023
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