Healthcare Provider Details

I. General information

NPI: 1134066707
Provider Name (Legal Business Name): JANET RAVELO GRAVE DE PERALTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9776 SW 147TH CT
MIAMI FL
33196-1637
US

IV. Provider business mailing address

9776 SW 147TH CT
MIAMI FL
33196-1637
US

V. Phone/Fax

Practice location:
  • Phone: 786-407-1111
  • Fax:
Mailing address:
  • Phone: 786-407-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: