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
State | License ID | Taxonomies |
---|---|---|
OH | 35083524 | 207R00000X |
FL | ME97551 | 207R00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | 91170 | Other | BCBS |
FL | 277352000 | Medicaid | |
OH | 2500323 | Medicaid | |
H98407 | Medicare UPIN | ||
FL | AB024Z | Medicare PIN | |
OH | 4121914 | Medicare ID - Type Unspecified | |
OH | 2500323 | Medicaid |