Organization
BRICENO MARTIN P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARIA BRICENO OD (OPTOMETRIST)
(786) 251-2719
Entity
Organization
Contact information
Practice address
14750 NW 77TH CT, MIAMI LAKES, FL 33016-1507
(786) 251-2719
Mailing address
14750 NW 77TH CT STE 110, MIAMI LAKES, FL 33016-1507
(305) 456-7313
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC4209
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000019400
—
FL
05
—
AI848Z
—
FL
Enumeration date
11/02/2017
Last updated
02/03/2020
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