Provider Demographics
NPI:1891842910
Name:GARAVELLO, DESIREE (DC)
Entity type:Individual
Prefix:DR
First Name:DESIREE
Middle Name:
Last Name:GARAVELLO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:DESIREE
Other - Middle Name:
Other - Last Name:CRUSADE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:903 30TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-4407
Mailing Address - Country:US
Mailing Address - Phone:916-442-7474
Mailing Address - Fax:916-442-7477
Practice Address - Street 1:903 30TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-4407
Practice Address - Country:US
Practice Address - Phone:916-442-7474
Practice Address - Fax:916-442-7477
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26857111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor