Provider Demographics
NPI:1083034268
Name:REVERT FONT, MARIA LUISA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA LUISA
Middle Name:
Last Name:REVERT FONT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 230209
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77223-0209
Mailing Address - Country:US
Mailing Address - Phone:713-660-1880
Mailing Address - Fax:713-926-9105
Practice Address - Street 1:7635 CANAL ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77012-1143
Practice Address - Country:US
Practice Address - Phone:832-723-4303
Practice Address - Fax:713-926-9105
Is Sole Proprietor?:No
Enumeration Date:2014-04-26
Last Update Date:2014-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4034208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics