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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