Revilla, Fredy Jesus

Revilla, Fredy Jesus is an individual health care provider with primary practice located at 200 Patewood Dr Ste B350 , Greenville SC 29615-6337. He recently has only one registered license in Allopathic & Osteopathic Physicians / Neurology, which is considered as his primary health care specialty. Revilla, Fredy Jesus can be contacted via phone (864) 454-4500.

Contact Information

Primary practice address
200 Patewood Dr Ste B350 Greenville SC 29615-6337
Phone: (864) 454-4500
Fax: (864) 454-4505
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Neurology 2084N0400X 35083417 Ohio
Allopathic & Osteopathic Physicians / Neurology 2084N0400X 37641 South Carolina

Profile Details

NPI number 1760418610
LBN Legal business name Revilla, Fredy Jesus
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 23rd, 2006
Last updated Jun 29th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1760418610 NPPES
Ohio MEDICAID 2463614
Ohio MEDICAID 376417
Ohio Other P00113175

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