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General NPI Number Information
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NPI Number | 1457829194
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Entity Type | Individual
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Provider Name | JISEL HENRIQUEZ AU.D.
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Gender | Female
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Dates
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Enumeration Date | 11/12/2018
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Last Update Date | 10/21/2020
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Provider Practice Location Address
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Address Line | 3401 PGA BLVD STE 410
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-2825
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Country | US
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Telephone | 561-627-3773
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Fax |
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Provider Business Mailing Address
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Address Line | 1601 CLINT MOORE RD STE 215
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City | BOCA RATON
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State | FL
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Zip | 33487-5716
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Country | US
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Telephone | 19-393-9561
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | AY2235
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License Number State | FL
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