Individual
DERELIS MOVILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2531 30TH RD STE 1A, ASTORIA, NY 11102-2624
(718) 267-1102
Mailing address
2531 30TH RD STE 1A, ASTORIA, NY 11102-2624
(718) 267-1102
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
12/04/2023
Last updated
07/24/2024
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