Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | DO5566 | FL |
NPI | 1073121430 |
---|---|
Provider Name | Elvira R Diez |
First Address | Weston, FL 33327-2049 |
Second Address | Weston, FL 33327-2049 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2020 |
Last Update Date | 21/07/2020 |