MEDICARE: RAV CLINIC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1043022544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAV CLINIC INC

Provider Business Mailing Address
First Line	:	6367 TRAILS OF FOXFORD CT
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33415-5133
Country	:	US
Telephone Number	:	786-413-7593
Fax Number	:

Provider Business Practice Location Address
First Line	:	6367 TRAILS OF FOXFORD CT
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33415-5133
Country	:	US
Telephone Number	:	786-413-7593
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	YAIMA RUBIO RAVELO
Credential	:	APRN
Telephone Number	:	786-413-7593

Provider Enumeration Date	:	01/22/2025
Last Update Date	:	01/22/2025

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