Provider Demographics
NPI:1275161481
Name:ALFONSO, JESSICA MARIA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIA
Last Name:ALFONSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 SW 130TH AVE APT 1608
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-5231
Mailing Address - Country:US
Mailing Address - Phone:305-710-2870
Mailing Address - Fax:
Practice Address - Street 1:6100 SW 130TH AVE APT 1608
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-5231
Practice Address - Country:US
Practice Address - Phone:305-710-2870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-01
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5869225X00000X
FLOT20830225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist