Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | DO0004515 | FL |
NPI | 1033368782 |
---|---|
Provider Name | Mr. Rene V Perez-Jacome |
First Address | Hialeah, FL 33013-2515 |
Second Address | Hialeah, FL 33013-2515 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2008 |
Last Update Date | 22/10/2008 |