ANTONIO G. REVILLA JR., M.D. P.A.
Radiology at Commercial Blvd, Fort Lauderdale, FL

License number
Florida ME0021737
Category
Radiology
Type
Vascular Surgery
License number
Florida ME0021737
Category
Radiology
Type
Thoracic Surgery (Cardiothoracic Vascular Surgery)
Owner
Name: DR. ANTONIO G. REVILLA JR. M.D.
Title: PRESIDENT
Phone: (954) 772-0949
Address
Address
1880 E Commercial Blvd SUITE 3, Fort Lauderdale, FL 33308
National Provider ID: 1548532088
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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Antonio G. Revilla Jr., M.D., PA

1880 E Commercial Blvd, Fort Lauderdale, FL 33308

Status:
Inactive
Registration:
Jul 1, 1975
State ID:
479904
Business type:
Domestic for Profit Corporation
President, Director:
Antonio G. Revilla President, Director, inactive

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