Provider Demographics
NPI:1841824869
Name:BEZA, HECTOR L (OF)
Entity type:Individual
Prefix:MR
First Name:HECTOR
Middle Name:L
Last Name:BEZA
Suffix:
Gender:M
Credentials:OF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 E LAMBRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-3433
Mailing Address - Country:US
Mailing Address - Phone:813-789-0858
Mailing Address - Fax:
Practice Address - Street 1:812 W MLK BLVD STE 100
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-3338
Practice Address - Country:US
Practice Address - Phone:813-224-0525
Practice Address - Fax:813-224-0622
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLORF270225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic FitterGroup - Single Specialty