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Individual

SELENA G CARMONA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
216 HOOK RD, HONEA PATH, SC 29654-7819
(864) 865-1008
(800) 340-0223
Mailing address
216 HOOK RD, HONEA PATH, SC 29654-7819
(864) 865-1008
(800) 340-0223

Taxonomy

Speciality
Code
Description
License number
State
305S00000X
Point of Service
374U00000X
Home Health Aide
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
103724712
DRIVERS LICENSE
SC
Enumeration date
08/09/2019
Last updated
08/09/2019
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