Most Relevant Information
Provider Data
| NPI Number: | 1003465402 |
| Provider Name: | MONIESHA AVITA JAVON BULLOCK |
| Entity Type: | Individual |
| Taxonomy Code: | 253Z00000X |
| Specialty: | In Home Supportive Care |
| License Number: |
Most Important Dates
| Enumeration Date: | 09/09/2019 |
| Last Updated: | 09/09/2019 |
Provider Practice Location
508 LITTLE MARGARET LN
HENRICO
VA
230751647
Practice Location Phone/Fax
| Phone: | 8048228661 |
| Fax: |
Provider Mailing Location
508 LITTLE MARGARET LN
HENRICO
VA
230751647
Provider Mailing Phone/Fax
| Phone: | 8048228661 |
| Fax: |