Healthcare Provider Details

I. General information

NPI: 1679187702
Provider Name (Legal Business Name): JENNIFER BIALOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2020
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date: 09/14/2020
Reactivation Date: 04/07/2021

III. Provider practice location address

900 27TH AVE
VERO BEACH FL
32960-4011
US

IV. Provider business mailing address

1866 35TH AVE
VERO BEACH FL
32960-2521
US

V. Phone/Fax

Practice location:
  • Phone: 772-569-5699
  • Fax:
Mailing address:
  • Phone: 772-925-4861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: