Individual
CASEY S REVENKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
350 30TH ST STE 100, OAKLAND, CA 94609-3422
(510) 204-1844
Mailing address
PO BOX 276950, SACRAMENTO, CA 95827-6950
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
PA56633
CA
363A00000X
Physician Assistant
Primary
PA56633
CA
Other
Enumeration date
05/15/2019
Last updated
12/31/2024
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