# BRICENO MARTIN P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386156081
- **Authorized official:** DR. MARIA BRICENO OD (OPTOMETRIST)
- **Authorized official phone:** (786) 251-2719

## Contact information

- **Practice address:** 14750 NW 77TH CT, MIAMI LAKES, FL 33016-1507
- **Practice address phone:** (786) 251-2719
- **Mailing address:** 14750 NW 77TH CT STE 110, MIAMI LAKES, FL 33016-1507
- **Mailing address phone:** (305) 456-7313

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | OPC4209 | FL | Yes |

## Other

- **Enumeration date:** 11/02/2017
- **Last updated:** 02/03/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 000019400 | — | FL |
| 05 | — | AI848Z | — | FL |