Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | DO2224 | FL |
NPI | 1053705558 |
---|---|
Provider Name | Jose A Conesa |
First Address | Miami, FL 33165-8015 |
Second Address | Miami, FL 33165-8015 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2015 |
Last Update Date | 23/03/2015 |