Individual
MELLVVA GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12948 TRADE PORT PL, RIVERVIEW, FL 33579-4269
(813) 770-3815
Mailing address
PO BOX 513, RIVERVIEW, FL 33568-0513
(813) 770-3815
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
23296698Z
FL
Other
Enumeration date
01/12/2022
Last updated
01/12/2022
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