Individual
MR. PEDRO VIVENTE GUACHICHULCA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CASAC
Contact information
Practice address
2367 2ND AVE, NEW YORK, NY 10035-3108
(212) 876-2300
(212) 722-7618
Mailing address
2367 2ND AVE, NEW YORK, NY 10035
(212) 876-2300
(212) 722-7618
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
12891
NY
Other
Enumeration date
09/18/2008
Last updated
09/18/2008
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