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Individual

GLORIA YVETTE REVILLA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
3130 S BRAHMA BLVD, KINGSVILLE, TX 78363-7257
(361) 592-8700
Mailing address
6809 HOLIDAY LN, CORPUS CHRISTI, TX 78414-2724

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
213696
TX

Other

Enumeration date
08/14/2018
Last updated
08/14/2018
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