Healthcare Provider Details

I. General information

NPI: 1386437028
Provider Name (Legal Business Name): LUIS JOEL RAVELO APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2025
Last Update Date: 05/26/2025
Certification Date: 05/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4960 SW 72ND AVE STE 303
MIAMI FL
33155-5550
US

IV. Provider business mailing address

11920 SW 184TH ST
MIAMI FL
33177-2462
US

V. Phone/Fax

Practice location:
  • Phone: 305-591-1606
  • Fax: 305-591-1618
Mailing address:
  • Phone: 786-608-4955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11039433
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: