Aldo Enrique Revilla, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

5287 Issued in AZ

Practice address

249 W. Ponderosa Street
Whiteriver, AZ 85941

Phone

(928) 338-4811

NPI assigned

Oct 13, 2017

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Dr. Aldo Revilla Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1507852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774224000000",
    "number": "1548771876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1170 N WOODLAND RD",
            "city": "LAKESIDE",
            "state": "AZ",
            "postal_code": "859297207",
            "telephone_number": "928-551-5190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "249 W. PONDEROSA STREET",
            "city": "WHITERIVER",
            "state": "AZ",
            "postal_code": "85941",
            "telephone_number": "928-338-4811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REVILLA",
        "first_name": "ALDO",
        "middle_name": "ENRIQUE",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-10-13",
        "last_updated": "2026-03-23",
        "certification_date": "2026-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "AZ",
            "license": "5287",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALDO",
            "last_name": "REVILLA",
            "prefix": "DR.",
            "credential": "PHD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Psychologist in Whiteriver, AZ
• Providers in Whiteriver, AZ by specialty
• Psychologist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.