Provider Demographics
NPI:1073247193
Name:RAVALO, CHERRY CORTEZ (AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:CHERRY
Middle Name:CORTEZ
Last Name:RAVALO
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 W SPARKLEBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-5012
Mailing Address - Country:US
Mailing Address - Phone:714-747-4185
Mailing Address - Fax:
Practice Address - Street 1:203 W SPARKLEBERRY AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92865-5012
Practice Address - Country:US
Practice Address - Phone:714-747-4185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95018603363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care