Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | ME110080 | FL |
NPI | 1003075177 |
---|---|
Provider Name | Renu R Ravi |
First Address | Coral Gables, FL 33146 |
Second Address | Coral Gables, FL 33146 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2008 |
Last Update Date | 16/12/2014 |