Individual
MR. DIVINE DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
350 E 143RD ST APT 5B, BRONX, NY 10454-1244
(646) 303-0863
Mailing address
350 E 143RD ST APT 5B, BRONX, NY 10454-1244
(646) 303-0863
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
—
NY
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
01/17/2019
Last updated
01/17/2019
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