Martha Lorena Revollo, M.D.

Primary specialty

Pediatric Endocrinology PhysicianTaxonomy code 2080P0205X

License

141493 Issued in FL

Practice address

9980 Central Park Blvd N
Boca Raton, FL 33428-1762

Phone

(561) 558-1212

NPI assigned

Mar 6, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: mrevollo1374394@direct.hopkinsmedicine.org

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.

• Pediatric Physician Services, Inc.

  • Pediatrics Physician
  • St Petersburg, FL
  • NPI 1770532798
  NPD (past)
• Seminole Tribe of Florida Health Dept.

  • Primary Care Clinic/Center
  • Hollywood, FL
  • NPI 1144551748
  NPD (past)

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

{
    "created_epoch": "1362528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658188800000",
    "number": "1720329378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9980 CENTRAL PARK BLVD N",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334281762",
            "telephone_number": "561-558-1212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9980 CENTRAL PARK BLVD N",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334281762",
            "telephone_number": "561-558-1212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REVOLLO",
        "first_name": "MARTHA",
        "middle_name": "LORENA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-03-06",
        "last_updated": "2022-07-19",
        "certification_date": "2022-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0205X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Endocrinology",
            "state": "FL",
            "license": "141493",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Revival Therapy LLC
• Revive Counseling LLC
• Revive Family Chiropractic LLC
• Revive Management Company LLC
• Revivify Dermatology, LLC
• Revolution Physical Therapy, LLC
• Jessica Revord, BCBA
• Kelly Lauren Reyer, PHARMD
• Mark Reyer, M.D.
• Edward Gonzalo Reyes Caceres, MA94672

• Pediatric Endocrinology Physician in Boca Raton, FL
• Providers in Boca Raton, FL by specialty
• Pediatric Endocrinology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2022; 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.