Provider Demographics
NPI:1780285437
Name:TRAVI HEALTH CARE LLC
Entity type:Organization
Organization Name:TRAVI HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDDY
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAVIESO INCLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-279-6508
Mailing Address - Street 1:14050 SW 84TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-4440
Mailing Address - Country:US
Mailing Address - Phone:210-279-6508
Mailing Address - Fax:
Practice Address - Street 1:14050 SW 84TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-4440
Practice Address - Country:US
Practice Address - Phone:210-279-6508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-07
Last Update Date:2020-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management