Doreva R Kinlaw | Bronx, NY • PECOS Search

Doreva R Kinlaw

Specialist

Other Service Providers

598 Grand Concourse, 2nd Fl, Bronx, NY 10451-1706

PECOS Enrollment

Based on the most recent information from CMS, provider Doreva R Kinlaw does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 39 days ago.

Profile Details

Provider ID
1407546237
Provider Type
Individual
Full Name
Kinlaw, Doreva R
Credential
ESTHETICIAN

Gender
Female
Sole Proprietor
Yes
Enumeration Date
5/15/2023
Last Updated
9/11/2024

Contact Information

Practice Location

598 Grand Concourse, 2nd Fl, Bronx, NY 10451-1706

Unlisted Fax

Mailing Location

598 Grand Concourse, 2nd Fl, Bronx, NY 10451-1706

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 174400000X Primary	Description Specialist Other Service Providers	License AEE-23-00186 New York