Healthcare Provider Details

I. General information

NPI: 1437109162
Provider Name (Legal Business Name): DIANA CAJAMARCA OD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N CONGRESS AVE SUITE 150
BOYNTON BEACH FL
33426-3338
US

IV. Provider business mailing address

3050 NORWOOD PL N-110
BOCA RATON FL
33431-6524
US

V. Phone/Fax

Practice location:
  • Phone: 561-734-2172
  • Fax: 561-734-2847
Mailing address:
  • Phone: 561-445-9979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberOP0003574
License Number StateFL

VIII. Authorized Official

Name: DR. DIANA CAJAMARCA
Title or Position: OPTOMETRIST/DIRECTOR
Credential: O.D.
Phone: 561-445-9979