Provider Demographics
NPI:1003863804
Name:A A HEALTH CARE MEDICAL CENTER
Entity Type:Organization
Organization Name:A A HEALTH CARE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALFONSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-631-6595
Mailing Address - Street 1:1701 W FLAGLER ST
Mailing Address - Street 2:SUITE 215
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-2098
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1701 W FLAGLER ST
Practice Address - Street 2:SUITE 215
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2098
Practice Address - Country:US
Practice Address - Phone:305-631-6595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69826174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9769Medicare ID - Type Unspecified