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General NPI Number Information
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NPI Number | 1710211412
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Entity Type | Individual
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Provider Name | JENNIFER BAUZA O.D.
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Gender | Female
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Dates
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Enumeration Date | 09/28/2009
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Last Update Date | 01/19/2012
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Provider Practice Location Address
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Address Line | 12055 PINES BLVD
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-4112
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Country | US
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Telephone | 754-400-2015
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Fax |
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Provider Business Mailing Address
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Address Line | 5231 W 25TH CT
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City | HIALEAH
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State | FL
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Zip | 33016-4072
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Country | US
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Telephone | 786-333-3338
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC4423
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License Number State | FL
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