Healthcare Provider Details

I. General information

NPI: 1679227326
Provider Name (Legal Business Name): SMART HEALTH & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2022
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27372 ALISO CREEK RD STE 200
ALISO VIEJO CA
92656-5339
US

IV. Provider business mailing address

27372 ALISO CREEK RD STE 200
ALISO VIEJO CA
92656-5339
US

V. Phone/Fax

Practice location:
  • Phone: 949-520-1012
  • Fax: 949-520-1045
Mailing address:
  • Phone: 818-579-2362
  • Fax: 818-579-2377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: RAYMOND BENJAMIN RAVEN
Title or Position: CEO & PARTNER
Credential:
Phone: 818-579-2362