Provider Demographics
NPI:1558865469
Name:RAVAID, AAMENAH
Entity Type:Individual
Prefix:
First Name:AAMENAH
Middle Name:
Last Name:RAVAID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 PRIEBE ST
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-5326
Mailing Address - Country:US
Mailing Address - Phone:209-684-8675
Mailing Address - Fax:
Practice Address - Street 1:1011 PRIEBE STREET
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-9524
Practice Address - Country:US
Practice Address - Phone:209-684-8675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician