Provider Demographics
NPI:1508682675
Name:RAVELO, RAUL ALEXANDER
Entity type:Individual
Prefix:
First Name:RAUL
Middle Name:ALEXANDER
Last Name:RAVELO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ALEX
Other - Middle Name:
Other - Last Name:RAVELO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1815 E HEIM AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-3016
Mailing Address - Country:US
Mailing Address - Phone:714-640-6891
Mailing Address - Fax:
Practice Address - Street 1:1815 E HEIM AVE STE 205
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92865-3016
Practice Address - Country:US
Practice Address - Phone:714-640-6891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician