Individual
MS. CORNELIA VIVECA MANTOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1045 E 230 STREET, BRONX, NY 10466
(718) 882-3675
Mailing address
P.O BOX 1378, 1045 EAST 230 STREET, BRONX, NY 10466
(715) 882-3675
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
296987-1
NY
Other
Enumeration date
08/27/2012
Last updated
09/21/2012
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