Individual
REINALD ALLEN REVILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
23700 CAMINO DEL SOL, TORRANCE, CA 90505
(310) 530-1151
Mailing address
PO BOX 4570, PALOS VERDES PENINSULA, CA 90274-9607
(424) 400-7748
(424) 400-7749
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
758060
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95007937
CA
Other
Enumeration date
09/24/2017
Last updated
01/22/2019
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