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General NPI Number Information
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NPI Number | 1992103303
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Entity Type | Organization
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Legal Business Name | REVESZ FAMILY MEDICINE
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Dates
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Enumeration Date | 12/17/2014
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Last Update Date | 12/17/2014
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Provider Practice Location Address
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Address Line | 5444 LAUREL HILLS DRIVE
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City | SACRAMENTO
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State | CA
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Zip | 95841-3106
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Country | US
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Telephone | 916-331-1333
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Fax | 916-331-1820
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Provider Business Mailing Address
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Address Line | 5444 LAUREL HILLS DRIVE
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City | SACRAMENTO
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State | CA
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Zip | 95841-3106
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Country | US
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Telephone | 916-331-1333
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Fax | 916-331-1820
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Authorized Official
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Title or Position | OWNER
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Name | THOMAS I REVESZ
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Credential | MD
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Telephone | 916-331-1333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A52294
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License Number State | CA
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