Individual
CORONA LAVETTA CALVARY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
412 OLD TROLLEY RD STE B, SUMMERVILLE, SC 29485-5666
(843) 345-8178
Mailing address
412 OLD TROLLEY RD STE B, SUMMERVILLE, SC 29485-5666
(843) 345-8178
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
008818045
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
88-2773025
—
SC
Enumeration date
07/03/2022
Last updated
07/03/2022
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