Provider Demographics
NPI:1033749361
Name:CARAVEO, MIRIAM (RDHAP)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:CARAVEO
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 S RIDGEWOOD DR APT 3
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-1758
Mailing Address - Country:US
Mailing Address - Phone:626-709-0624
Mailing Address - Fax:
Practice Address - Street 1:2424 S RIDGEWOOD DR APT 3
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792-1758
Practice Address - Country:US
Practice Address - Phone:626-709-0624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-26
Last Update Date:2020-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAP763124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist