Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 1553 | FL |
NPI | 1083881627 |
---|---|
Provider Name | Rodolfo Alonso SR. |
First Address | Hialeah, FL 33012 |
Second Address | Hialeah, FL 33012-4424 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2008 |
Last Update Date | 13/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
086450100 | (05) | FL |