Provider Demographics
NPI:1619980471
Name:ILAR-REVILLA, MARIA CARIDAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:CARIDAD
Last Name:ILAR-REVILLA
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 1:94-866 MOLOALO ST # 1B
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-3349
Mailing Address - Country:US
Mailing Address - Phone:808-677-5832
Mailing Address - Fax:808-671-9109
Practice Address - Street 1:94-866 MOLOALO ST # 1B
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3354
Practice Address - Country:US
Practice Address - Phone:808-677-5832
Practice Address - Fax:808-671-9109
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI9394207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine