Healthcare Provider Details

I. General information

NPI: 1295773257
Provider Name (Legal Business Name): FERNANDO RAVESSOUD, M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 12/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3918 LONG BEACH BLVD SUITE 180
LONG BEACH CA
90807-2666
US

IV. Provider business mailing address

3918 LONG BEACH BLVD SUITE 180
LONG BEACH CA
90807-2666
US

V. Phone/Fax

Practice location:
  • Phone: 562-595-5424
  • Fax: 562-595-8927
Mailing address:
  • Phone: 562-595-5424
  • Fax: 562-595-8927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: FERNANDO RAVESSOUD
Title or Position: CFO
Credential: M.D.
Phone: 562-595-5424