Provider Demographics
NPI:1609531151
Name:RAVESSOUD ORTHOPEDICS AND SPINE, PC
Entity Type:Organization
Organization Name:RAVESSOUD ORTHOPEDICS AND SPINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:ATILIO
Authorized Official - Last Name:RAVESSOUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-787-3803
Mailing Address - Street 1:880 S. TELSHORE BL. #200
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8398
Mailing Address - Country:US
Mailing Address - Phone:575-222-0037
Mailing Address - Fax:575-571-4592
Practice Address - Street 1:880 S. TELSHORE BL. #200
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8398
Practice Address - Country:US
Practice Address - Phone:575-222-0037
Practice Address - Fax:575-571-4592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty