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General NPI Number Information
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NPI Number | 1639632763
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Entity Type | Organization
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Legal Business Name | ACUTE CARE
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Dates
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Enumeration Date | 04/06/2019
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Last Update Date | 04/16/2021
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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 | 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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Authorized Official
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Title or Position | DOCTOR OF OPTOMETRY
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Name | MR. RAVEN SHENETTE MAYES
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Credential | DO
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Telephone | 352-792-8069
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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