Provider Demographics
NPI:1053987032
Name:DVAWORLDRX, LLC
Entity type:Organization
Organization Name:DVAWORLDRX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:CELES
Authorized Official - Last Name:MANZANILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-241-2782
Mailing Address - Street 1:274 KENNEBEC ST
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-6206
Mailing Address - Country:US
Mailing Address - Phone:781-241-2782
Mailing Address - Fax:857-703-2625
Practice Address - Street 1:274 KENNEBEC ST
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-6206
Practice Address - Country:US
Practice Address - Phone:781-241-2782
Practice Address - Fax:857-703-2625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier