Active NPI
Maria Elisabet Revilla, PHD
- Psychologist
- Stockton, CA
National Provider Identifier
1518277433
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY 23560
- Practice address
- 1350 W Robinhood Dr Ste 18
Stockton, CA 95207-5519 - Phone
- (650) 279-2332
- NPI assigned
- Oct 13, 2010
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY 23560 | CA | Primary |
Addresses
Primary practice location
1350 W Robinhood Dr Ste 18
Stockton, CA 95207-5519
Mailing address
711 Church St
Mountain View, CA 94041-2030
Phone (650) 965-2020
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 23560 | CA | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Community Health Awareness Council | Past | Accepting new patients | |
| Community Health Awareness Council | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Mountain View, CA
- NPI 1598809071
-
- Community/Behavioral Health Agency
- Mountain View, CA
- NPI 1891839379
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1286928000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1291248000000",
"number": "1518277433",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "711 CHURCH ST",
"city": "MOUNTAIN VIEW",
"state": "CA",
"postal_code": "940412030",
"telephone_number": "650-965-2020",
"fax_number": "650-965-7286"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1350 W ROBINHOOD DR STE 18",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952075519",
"telephone_number": "650-279-2332"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REVILLA",
"first_name": "MARIA",
"middle_name": "ELISABET",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-10-13",
"last_updated": "2010-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY 23560",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stockton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.