Provider Demographics
NPI:1801175377
Name:RAVEN-L INC.
Entity type:Organization
Organization Name:RAVEN-L INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:KEIKO
Authorized Official - Last Name:RAVENELLE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:626-441-3124
Mailing Address - Street 1:1962 MILAN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-4635
Mailing Address - Country:US
Mailing Address - Phone:626-441-3124
Mailing Address - Fax:626-441-3124
Practice Address - Street 1:1962 MILAN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-4635
Practice Address - Country:US
Practice Address - Phone:626-441-3124
Practice Address - Fax:626-441-3124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT644225200000X
CAPT 14400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty