Provider Demographics
NPI:1982394615
Name:EC BOUTIQUE FLORIDA CORP
Entity Type:Organization
Organization Name:EC BOUTIQUE FLORIDA CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURE
Authorized Official - Prefix:MRS
Authorized Official - First Name:LIZZETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:IRIZARRY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-544-8878
Mailing Address - Street 1:138 AVE WINSTON CHURHILL
Mailing Address - Street 2:PMB 674
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:954-600-9002
Mailing Address - Fax:
Practice Address - Street 1:12801 W SUNRISE BLVD STE 259
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-4002
Practice Address - Country:US
Practice Address - Phone:787-998-4514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier