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Individual

JOHN RANDALL REVELLAME

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
TECHNICIAN

Contact information

Practice address
7365 CARNELIAN ST STE 112, RANCHO CUCAMONGA, CA 91730-1156
(951) 344-5023
Mailing address
7365 CARNELIAN ST STE 112, RANCHO CUCAMONGA, CA 91730-1156
(951) 344-5023

Taxonomy

Speciality
Code
Description
License number
State
374700000X
Technician
Primary
CA

Other

Enumeration date
01/29/2026
Last updated
01/31/2026
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