Provider Demographics
NPI:1013797349
Name:SANTOS RAVELO, HELEN
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:
Last Name:SANTOS RAVELO
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 1:18170 NW 59TH AVE APT 203
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5673
Mailing Address - Country:US
Mailing Address - Phone:786-991-6617
Mailing Address - Fax:
Practice Address - Street 1:18170 NW 59TH AVE APT 203
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5673
Practice Address - Country:US
Practice Address - Phone:786-991-6617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-298379106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty