Provider Demographics
NPI:1376524223
Name:ALONSO, LUZ A (MD)
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:A
Last Name:ALONSO
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 1:201 N PARK AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-4147
Mailing Address - Country:US
Mailing Address - Phone:407-889-1030
Mailing Address - Fax:407-889-1035
Practice Address - Street 1:201 N PARK AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-4147
Practice Address - Country:US
Practice Address - Phone:407-889-1030
Practice Address - Fax:407-889-1035
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35083524207R00000X
FLME97551207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL91170OtherBCBS
FL277352000Medicaid
OH2500323Medicaid
H98407Medicare UPIN
FLAB024ZMedicare PIN
OH4121914Medicare ID - Type Unspecified
OH2500323Medicaid