Healthcare Provider Details

I. General information

NPI: 1609531151
Provider Name (Legal Business Name): RAVESSOUD ORTHOPEDICS AND SPINE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2021
Last Update Date: 11/01/2021
Certification Date: 09/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 S. TELSHORE BL. #200
LAS CRUCES NM
88011-8398
US

IV. Provider business mailing address

880 S. TELSHORE BL. #200
LAS CRUCES NM
88011-8398
US

V. Phone/Fax

Practice location:
  • Phone: 575-222-0037
  • Fax: 575-571-4592
Mailing address:
  • Phone: 575-222-0037
  • Fax: 575-571-4592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: FERNANDO ATILIO RAVESSOUD
Title or Position: PRESIDENT AND OWNER
Credential: MD
Phone: 562-787-3803