Individual
JANNELIZ VEGA-MORELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
59 KEITH AVE # 2, BROCKTON, MA 02301-6817
(857) 424-9316
Mailing address
59 KEITH AVE # 2, BROCKTON, MA 02301-6817
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
S13104860
MA
Other
Enumeration date
11/08/2021
Last updated
11/08/2021
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