Individual
FAZEILA OVALLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PBT
Contact information
Practice address
111 AVALON GARDENS DR, NANUET, NY 10954-7415
(845) 390-0769
Mailing address
111 AVALON GARDENS DR, NANUET, NY 10954-7415
(845) 390-0769
Taxonomy
Speciality
Code
Description
License number
State
374700000X
Technician
Primary
Q7F2D7H4
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
92-1618759
PHLEBOTOMIST
NY
Enumeration date
02/27/2023
Last updated
02/27/2023
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