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Organization
LA LAKERS
Active
Organization
LA LAKERS
Active
Parent organization
000018
Organization subpart
Yes
Provider details
NPI number
Legal business name
000018
Authorized official
RAVEN SHENETTE MAYES DO (HEALTHCARE MANAGER)
(352) 792-8069
Entity
Organization
Contact information
Practice address
2101 NE 2ND ST APT 114, GAINESVILLE, FL 32609-8626
(352) 792-8069
Mailing address
2101 NE 2ND ST APT 114, GAINESVILLE, FL 32609-8626
(352) 792-8069
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1324114-11-26-2010
VISN 8 DIVERSITY TRAINING
DC
01
—
1337502-11-26-2010
RIGHT SIDED EKG
DC
01
—
1339073-10-01-2009
BLS (BASIC LIFE SUPPORT) HEALTHCARE PROVIDER
DC
01
—
1339076-10-01-2009
BLS (BASIC LIFE SUPPORT) HEALTHCARE PROVIDER CHALLENGE
DC
01
—
32432-07-14-2008
VHA PROVIDER PRIVACY TRAINING
DC
Enumeration date
04/06/2019
Last updated
04/16/2021
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