Provider Demographics
NPI:1376928655
Name:SZABO, ALEX SANDOR
Entity Type:Individual
Prefix:MR
First Name:ALEX
Middle Name:SANDOR
Last Name:SZABO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 SW TODD AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-3061
Mailing Address - Country:US
Mailing Address - Phone:772-201-1789
Mailing Address - Fax:772-353-5703
Practice Address - Street 1:372 SW TODD AVE
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-3061
Practice Address - Country:US
Practice Address - Phone:772-201-1789
Practice Address - Fax:772-353-5703
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12687310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility