Provider Demographics
NPI:1649513706
Name:MEVOICY, BALAGUEL
Entity type:Individual
Prefix:
First Name:BALAGUEL
Middle Name:
Last Name:MEVOICY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 ELDRON BLVD NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-3088
Mailing Address - Country:US
Mailing Address - Phone:321-373-7262
Mailing Address - Fax:321-373-7024
Practice Address - Street 1:193 ELDRON BLVD NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-3088
Practice Address - Country:US
Practice Address - Phone:321-373-7262
Practice Address - Fax:321-373-7024
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness