Provider Demographics
NPI:1356239511
Name:REVELES, CARMELLO SR
Entity type:Individual
Prefix:
First Name:CARMELLO
Middle Name:
Last Name:REVELES
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 S SHEPARD AVE
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-6357
Mailing Address - Country:US
Mailing Address - Phone:405-496-3742
Mailing Address - Fax:
Practice Address - Street 1:1950 S SHEPARD AVE
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-6357
Practice Address - Country:US
Practice Address - Phone:405-496-3742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator