Organization
LA LAKERS
Active
Other names
Attn: Jamie Bus Adam Silver
Organization subpart
No
Provider details
NPI number
Authorized official
RAVEN MAYES DO ONA CNA APN (OSTEOPATHIC MEDICINE PHYSICIAN)
(352) 792-8069
Entity
Organization
Contact information
Practice address
2101 NE 2ND ST APT 114, GAINESVILLE, FL 32609-8626
(352) 792-8069
Mailing address
PO BOX 5393, GAINESVILLE, FL 32627-5393
(352) 792-8069
Taxonomy
Speciality
Code
Description
License number
State
174200000X
Meals Provider
—
—
251E00000X
Home Health Agency
—
—
251J00000X
Nursing Care Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QA0005X
Ambulatory Family Planning Facility
—
—
261QE0002X
Emergency Care Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
332100000X
Department of Veterans Affairs (VA) Pharmacy
—
—
333600000X
Pharmacy
—
—
385H00000X
Respite Care
—
—
Other
Enumeration date
11/05/2021
Last updated
11/05/2021
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