Provider Demographics
NPI:1215230370
Name:HUMBERTO R. RAVELO, INC.
Entity Type:Organization
Organization Name:HUMBERTO R. RAVELO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HUMBERTO
Authorized Official - Middle Name:ROGELIO
Authorized Official - Last Name:RAVELO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-427-4752
Mailing Address - Street 1:2865 ATLANTIC AVE
Mailing Address - Street 2:215
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1740
Mailing Address - Country:US
Mailing Address - Phone:562-427-4752
Mailing Address - Fax:562-492-6262
Practice Address - Street 1:2865 ATLANTIC AVE
Practice Address - Street 2:215
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1740
Practice Address - Country:US
Practice Address - Phone:562-427-4752
Practice Address - Fax:562-492-6262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42849208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty