Provider Demographics
NPI:1497513444
Name:REVELAS, BRINA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:BRINA
Middle Name:
Last Name:REVELAS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:MS
Other - First Name:BRINA
Other - Middle Name:
Other - Last Name:REVELAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:155 N SINGINGWOOD ST UNIT 53
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-5717
Mailing Address - Country:US
Mailing Address - Phone:714-396-3102
Mailing Address - Fax:
Practice Address - Street 1:155 N SINGINGWOOD ST UNIT 53
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-5717
Practice Address - Country:US
Practice Address - Phone:714-396-3102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95029401207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine