Individual
EDENA PAVILIS RAYMOND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SOLO PROVIDER
Contact information
Practice address
9822 BROOKFIELD FARM CT APT 203, RIVERVIEW, FL 33578-7575
(813) 458-2859
(813) 398-5801
Mailing address
9822 BROOKFIELD FARM CT APT 203, RIVERVIEW, FL 33578-7575
(813) 458-2859
(813) 398-5801
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017204400
—
FL
Enumeration date
10/18/2017
Last updated
10/18/2017
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