Individual
JUVAILA PAVLICEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6121 N HANLEY RD, BERKELEY, MO 63134-2003
(314) 615-0500
(314) 615-8303
Mailing address
6121 N HANLEY RD, BERKELEY, MO 63134-2003
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
2013020789
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2013020781
LICENSE NUMBER
MO
Enumeration date
12/26/2013
Last updated
12/26/2013
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