Individual
KATHERINE BERENICE CAMPOVERDE AREVALO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1157 BILLIGS CT SE, AP# 1A, GRAND RAPIDS, MI 49508
(347) 724-5845
Mailing address
9838 57TH AVE APT 2J, CORONA, NY 11368-4918
(347) 724-5845
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
524398310
NY
Other
Enumeration date
09/21/2016
Last updated
09/24/2019
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