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General NPI Number Information
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NPI Number | 1205471687
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Entity Type | Organization
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Legal Business Name | SENIA V BUSTILLO OD PA
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Dates
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Enumeration Date | 11/09/2019
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Last Update Date | 11/09/2019
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Provider Practice Location Address
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Address Line | 8765 SW 165TH AVENUE SUITE 107
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City | MIAMI
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State | FL
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Zip | 33193
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Country | US
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Telephone | 786-212-1270
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Fax |
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Provider Business Mailing Address
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Address Line | 8765 SW 165TH AVE STE 107
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City | MIAMI
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State | FL
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Zip | 33193-5832
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Country | US
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Telephone | 786-212-1270
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SENIA BUSTILLO
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Credential | OD
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Telephone | 786-212-1270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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