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1497781777
JOSE J PROVENCIO
CHARLOTTESVILLE, VA
NPI
1497781777
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
2084N0400X Psychiatry & Neurology, Neurology
(Licence: VA 0101056026)
Enumeration Date
2006-06-25
Last Update Date
2020-10-09
Business Address
JOSE J PROVENCIO M.D.
1215 LEE ST
CHARLOTTESVILLE, VA 22908-0001
Phone number: 434-924-2101
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Mailing Address
JOSE J PROVENCIO M.D.
PO BOX 9007
CHARLOTTESVILLE, VA 22906-9007
Phone number:
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