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General NPI Number Information
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NPI Number | 1558829721
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Entity Type | Individual
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Provider Name | RAVEN SHENETTE MAYES JAMES ONA/MD/ARNP
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Gender | Female
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Dates
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Enumeration Date | 03/06/2019
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2275 E MARIPOSA AVE
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City | EL SEGUNDO
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State | CA
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Zip | 90245-5029
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Country | US
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Telephone | 310-426-6000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2303
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City | HAWTHORNE
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State | FL
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Zip | 32640-2303
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Country | US
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Telephone | 352-271-5000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 50-2560
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License Number State |
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | ONA21898
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 156F00000X
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Taxonomy Name | Technician/Technologist
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License Number | CNA92737
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License Number State |
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Taxonomy #4
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Taxonomy Code | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number | 7-0076
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License Number State | KY
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Taxonomy #5
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Taxonomy Code | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number | 50-1454
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License Number State | DC
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Taxonomy #6
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Taxonomy Code | 172A00000X
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Taxonomy Name | Driver
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License Number | M200-737-79-557-0
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License Number State | FL
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Taxonomy #7
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 50-2560
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License Number State | FL
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Taxonomy #8
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Taxonomy Code | 207U00000X
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Taxonomy Name | Nuclear Medicine Physician
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License Number | 50-2560
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License Number State | FL
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Taxonomy #9
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 50-4007
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License Number State | GA
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Taxonomy #10
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Taxonomy Code | 332100000X
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Taxonomy Name | Department of Veterans Affairs (VA) Pharmacy
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License Number | 50-2560
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License Number State | FL
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Taxonomy #11
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #12
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | CEP15022
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License Number State | CA
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Taxonomy #13
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | ABNP1418
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License Number State | AL
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Taxonomy #14
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | FLAPN559215
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License Number State | FL
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