Provider Demographics
NPI:1447088299
Name:RAVELLO NAVARRETE, NATALIA SUSANA
Entity type:Individual
Prefix:
First Name:NATALIA
Middle Name:SUSANA
Last Name:RAVELLO NAVARRETE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9813 SOMERSET WIND DR APT 104
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-5504
Mailing Address - Country:US
Mailing Address - Phone:954-496-1514
Mailing Address - Fax:
Practice Address - Street 1:9813 SOMERSET WIND DR APT 104
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-5504
Practice Address - Country:US
Practice Address - Phone:954-496-1514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-362533106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty