Provider Demographics
NPI:1326280066
Name:RAVAL FACIAL AESTHETICS, PC
Entity Type:Organization
Organization Name:RAVAL FACIAL AESTHETICS, PC
Other - Org Name:RAVAL FACIAL AESTHETICS AND ENT, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:R
Authorized Official - Last Name:RAVAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:303-381-3223
Mailing Address - Street 1:250 STEELE ST
Mailing Address - Street 2:#206
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-5225
Mailing Address - Country:US
Mailing Address - Phone:303-381-3223
Mailing Address - Fax:303-381-3213
Practice Address - Street 1:250 STEELE ST
Practice Address - Street 2:#206
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5225
Practice Address - Country:US
Practice Address - Phone:303-381-3223
Practice Address - Fax:303-381-3213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-26
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39382174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty