Provider Demographics
NPI:1548412869
Name:RAVENNA, JOSEPH JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:RAVENNA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15651 IMPERIAL HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-1628
Mailing Address - Country:US
Mailing Address - Phone:562-943-6715
Mailing Address - Fax:562-943-2665
Practice Address - Street 1:15651 IMPERIAL HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-1628
Practice Address - Country:US
Practice Address - Phone:562-943-6715
Practice Address - Fax:562-943-2665
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG7767207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine