Active NPI
Carol Revak, NMD
- Acupuncturist
- Tucson, AZ
National Provider Identifier
1154588127
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- AZ 97-0516
- Practice address
- 640 S Tudor PL
Tucson, AZ 85710-4256 - Phone
- (520) 749-9655
- Fax
- (520) 239-8515
- NPI assigned
- May 19, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | AZ 97-0516 | AZ | Primary |
Addresses
Primary practice location
640 S Tudor PL
Tucson, AZ 85710-4256
Mailing address
640 S Tudor PL
Tucson, AZ 85710-4256
Phone (520) 401-7595
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| AZ 97-05516 | Other | AZ | BUSINESS LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AZ 97-0516 | AZ | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1211155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1681689600000",
"number": "1154588127",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "640 S TUDOR PL",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857104256",
"telephone_number": "520-401-7595"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "640 S TUDOR PL",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857104256",
"telephone_number": "520-749-9655",
"fax_number": "520-239-8515"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REVAK",
"first_name": "CAROL",
"name_prefix": "Dr.",
"credential": "NMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-05-19",
"last_updated": "2023-04-17",
"certification_date": "2023-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "AZ",
"license": "AZ 97-0516",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BUSINESS LICENSE",
"identifier": "AZ 97-05516",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tucson, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.