Individual
ALDO ENRIQUE REVILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
249 W. PONDEROSA STREET, WHITERIVER, AZ 85941
(928) 338-4811
Mailing address
1170 N WOODLAND RD, LAKESIDE, AZ 85929-7207
(928) 551-5190
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
4858
PR
103T00000X
Psychologist
Primary
5287
AZ
Other
Enumeration date
10/13/2017
Last updated
03/23/2026
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