Provider Demographics
NPI:1629839584
Name:REVERON, ALBA YESSENIA
Entity Type:Individual
Prefix:
First Name:ALBA
Middle Name:YESSENIA
Last Name:REVERON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-4014
Mailing Address - Country:US
Mailing Address - Phone:203-465-9775
Mailing Address - Fax:
Practice Address - Street 1:157 CHURCH ST STE 1900
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-2100
Practice Address - Country:US
Practice Address - Phone:888-498-1669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator