Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 26205 | FL |
NPI | 1003487745 |
---|---|
Provider Name | Livet Boffil |
First Address | Doral, FL 33178-6079 |
Second Address | Doral, FL 33178-6079 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2021 |
Last Update Date | 04/07/2021 |