Individual
DIANA MARIZA REVELES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
352 L ST, CHULA VISTA, CA 91911-1208
(619) 515-2325
Mailing address
823 GATEWAY CENTER WAY, SAN DIEGO, CA 92102-4541
(619) 515-2300
(619) 906-4564
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA19306
CA
Other
Enumeration date
09/12/2007
Last updated
03/17/2018
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