Individual
LATAVIA EVANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5016 31ST AVE, 3A, WOODSIDE, NY 11377-1354
(718) 932-6703
Mailing address
5016 31ST AVE, 3A, WOODSIDE, NY 11377-1354
(718) 932-6703
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
NY
Other
Enumeration date
05/29/2013
Last updated
05/29/2013
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