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Individual

IRENE BASIL MASEVERIYO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
4505 W BURGESS LN, LAVEEN, AZ 85339-1919
(331) 803-0822
Mailing address
4505 W BURGESS LN, LAVEEN, AZ 85339-1919
(331) 803-0822

Taxonomy

Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
BH5585
AZ

Other

Enumeration date
01/15/2019
Last updated
01/15/2019
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