Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 4565 | FL |
NPI | 1043471535 |
---|---|
Provider Name | Mr. Diego Becerra |
First Address | Coral Springs, FL 33076-3302 |
Second Address | Coral Springs, FL 33076-3302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2008 |
Last Update Date | 18/06/2008 |