Individual
JUAN ANDRES REVILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BA
Contact information
Practice address
919 E 2ND ST, SANFORD, FL 32771-2101
(407) 321-3170
(407) 321-3488
Mailing address
919 E 2ND ST, SANFORD, FL 32771-2101
(407) 321-3170
(407) 321-3488
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1164581633
—
FL
Enumeration date
06/30/2008
Last updated
06/30/2008
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