MEDICARE: REVA SEWELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164X00000X	Licensed Vocational Nurse	754090	CA

General Provider Information

NPI Number	:	1275481699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REVA SEWELL

Provider Business Mailing Address
First Line	:	2300 RAINBOW CT # F3
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94501-7258
Country	:	US
Telephone Number	:	559-309-0662
Fax Number	:

Provider Business Practice Location Address
First Line	:	7200 BANCROFT AVE BLDG BSTE133
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94605-2403
Country	:	US
Telephone Number	:	559-309-0662
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2026
Last Update Date	:	03/20/2026

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Directions to “ REVA SEWELL ” Practice Location

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