Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DN20056 | FL |
NPI | 1023466992 |
---|---|
Provider Name | Luiz Alexandre Barbosa |
First Address | Boca Raton, FL 33498-6795 |
Second Address | Boca Raton, FL 33498-6795 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2016 |
Last Update Date | 01/06/2016 |