Individual
DAVANZO TATE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6602 HARVEST RIDGE DR, YOUNGSTOWN, OH 44515-5562
(330) 974-5415
Mailing address
6602 HARVEST RIDGE DR, YOUNGSTOWN, OH 44515-5562
(330) 974-5415
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
5004944
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0135706
—
OH
Enumeration date
10/20/2015
Last updated
10/20/2015
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