JOSE J PROVENCIO

CHARLOTTESVILLE, VA
NPI1497781777
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy2084N0400X Psychiatry & Neurology, Neurology
(Licence: VA  0101056026)
Enumeration Date2006-06-25
Last Update Date2020-10-09
Business Address
JOSE J PROVENCIO M.D.
1215 LEE ST
CHARLOTTESVILLE, VA 22908-0001
Phone number: 434-924-2101
Mailing Address
JOSE J PROVENCIO M.D.
PO BOX 9007
CHARLOTTESVILLE, VA 22906-9007
Phone number:
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