Provider Demographics
NPI:1326072448
Name:ALFONSO, TERESA B (MD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:B
Last Name:ALFONSO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6498 CORAL WAY
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155
Mailing Address - Country:US
Mailing Address - Phone:305-668-7047
Mailing Address - Fax:305-668-7199
Practice Address - Street 1:6498 CORAL WAY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155
Practice Address - Country:US
Practice Address - Phone:305-668-7047
Practice Address - Fax:305-668-7199
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0087045207R00000X
FLME87045207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266685500Medicaid
FLH59662Medicare ID - Type Unspecified
FLU0646AMedicare UPIN