Provider Demographics
NPI:1114321536
Name:ALZAMENDI, ROMINA POWERS (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ROMINA
Middle Name:POWERS
Last Name:ALZAMENDI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 HOLLYWOOD BLVD STE 215S
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-1227
Mailing Address - Country:US
Mailing Address - Phone:954-843-9443
Mailing Address - Fax:
Practice Address - Street 1:3000 SW 148TH AVE STE 250
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4177
Practice Address - Country:US
Practice Address - Phone:954-843-9443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-14
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
FLPA9108295363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9108295OtherPA LICENSE
FL013630100Medicaid