Individual
STEPHEN FRANCISCO REVILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
169 ASHLEY AVE RM 202, CHARLESTON, SC 29425-8905
(843) 792-2322
Mailing address
169 ASHLEY AVE, CHARLESTON, SC 29425-8905
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
LL82769
SC
Other
Enumeration date
06/12/2019
Last updated
06/12/2019
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