Provider Demographics
NPI:1912356346
Name:JARAVALERO, JOSEFA DEL CARMEN (EFDA)
Entity Type:Individual
Prefix:
First Name:JOSEFA
Middle Name:DEL CARMEN
Last Name:JARAVALERO
Suffix:
Gender:F
Credentials:EFDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4431 68TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT HOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76544-5042
Mailing Address - Country:US
Mailing Address - Phone:254-287-1225
Mailing Address - Fax:254-287-9685
Practice Address - Street 1:4431 68TH ST
Practice Address - Street 2:
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544-5042
Practice Address - Country:US
Practice Address - Phone:254-287-1225
Practice Address - Fax:254-287-9685
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1852126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant