Individual
GENEVA DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
665 THWAITES PL, SUITE6F, BRONX, NY 10467-7947
(718) 300-0374
Mailing address
665 THWAITES PL, SUITE6F, BRONX, NY 10467-7947
(718) 300-0374
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
211715933
NY
Other
Enumeration date
12/07/2015
Last updated
12/07/2015
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