Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH9005 | FL |
NPI | 1003980640 |
---|---|
Provider Name | Mrs. Therese Jocelyne Beauzile |
First Address | Miami, FL 33196-2819 |
Second Address | Miami, FL 33190-1003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
77830300 | (05) | FL |