Provider Demographics
NPI:1205672151
Name:BROCK, AVIS MARIA
Entity type:Individual
Prefix:
First Name:AVIS
Middle Name:MARIA
Last Name:BROCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3302 TOLEDANO STREET
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70125
Mailing Address - Country:US
Mailing Address - Phone:504-458-7979
Mailing Address - Fax:
Practice Address - Street 1:3306 MISSION VALLEY DR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-3701
Practice Address - Country:US
Practice Address - Phone:832-946-1019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider