Provider Demographics
NPI:1235159344
Name:FORTEZA, ALEJANDRO M (MD)
Entity Type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:M
Last Name:FORTEZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4960 SW 72ND AVE
Mailing Address - Street 2:SUITE 406
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-5544
Mailing Address - Country:US
Mailing Address - Phone:305-662-5200
Mailing Address - Fax:305-667-1275
Practice Address - Street 1:4960 SW 72ND AVE
Practice Address - Street 2:SUITE 406
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-5544
Practice Address - Country:US
Practice Address - Phone:305-662-5200
Practice Address - Fax:305-667-1275
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME639722084N0400X
FL00639722084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3740749Medicaid
FL3740749-00Medicaid
FLF70134Medicare UPIN
FL3740749-00Medicaid
FL3740749Medicaid