Healthcare Provider Details

I. General information

NPI: 1740475870
Provider Name (Legal Business Name): NHU TRUONG BETETA O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NHU QUYNH TRUONG O.D.

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 11/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5961 NW 173RD DR
HIALEAH FL
33015
US

IV. Provider business mailing address

1395 NW 167TH ST
MIAMI GARDENS FL
33169-5710
US

V. Phone/Fax

Practice location:
  • Phone: 305-556-7500
  • Fax: 305-851-5708
Mailing address:
  • Phone: 305-628-6117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC 4391
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: