Provider Demographics
NPI:1073245072
Name:REVCHUK, MEI-LING (MS)
Entity Type:Individual
Prefix:MS
First Name:MEI-LING
Middle Name:
Last Name:REVCHUK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:MEI-LING
Other - Middle Name:
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:18693 E CAVENDISH DR
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94552-1718
Mailing Address - Country:US
Mailing Address - Phone:909-919-3063
Mailing Address - Fax:
Practice Address - Street 1:18693 E CAVENDISH DR
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94552-1718
Practice Address - Country:US
Practice Address - Phone:909-919-3063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19599235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist