Provider Demographics
NPI:1003430539
Name:ALFONSO, IVETTE (CAA)
Entity Type:Individual
Prefix:
First Name:IVETTE
Middle Name:
Last Name:ALFONSO
Suffix:
Gender:F
Credentials:CAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14881 SW 158TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33187-0608
Mailing Address - Country:US
Mailing Address - Phone:305-562-9382
Mailing Address - Fax:
Practice Address - Street 1:8950 N KENDALL DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2144
Practice Address - Country:US
Practice Address - Phone:786-596-3621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAA573367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant