Provider Demographics
NPI:1508833104
Name:ALICEA BERRIOS, LUZ M (MD)
Entity Type:Individual
Prefix:MRS
First Name:LUZ
Middle Name:M
Last Name:ALICEA BERRIOS
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 1:1302 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-5042
Mailing Address - Country:US
Mailing Address - Phone:386-328-0108
Mailing Address - Fax:386-325-1086
Practice Address - Street 1:1425 DUNN AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114
Practice Address - Country:US
Practice Address - Phone:386-323-9600
Practice Address - Fax:386-323-9695
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8391208D00000X
FLACN880208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019698900Medicaid
FLIV081ZOtherFL M CARE
FLACN880OtherFLORIDA MEDICAL LICENSE
8286OtherCRUZ AZUL
8286OtherCRUZ AZUL
FL019698900Medicaid