Provider Demographics
NPI:1871174524
Name:REVERON-THORNTON, ROSYLI FRANCIS
Entity type:Individual
Prefix:MS
First Name:ROSYLI
Middle Name:FRANCIS
Last Name:REVERON-THORNTON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ROSYLI
Other - Middle Name:FRANCIS
Other - Last Name:REVERON MIRAMONTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 PASTEUR DR RM H3591
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-2200
Mailing Address - Country:US
Mailing Address - Phone:650-725-2181
Mailing Address - Fax:
Practice Address - Street 1:300 PASTEUR DR
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-2200
Practice Address - Country:US
Practice Address - Phone:650-723-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program