Provider Demographics
NPI:1518062249
Name:ALONSO, LEONARDO LAZARO (DO)
Entity Type:Individual
Prefix:DR
First Name:LEONARDO
Middle Name:LAZARO
Last Name:ALONSO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 CHICOPIT LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-4913
Mailing Address - Country:US
Mailing Address - Phone:904-221-8961
Mailing Address - Fax:
Practice Address - Street 1:8761 PERIMETER PARK BLVD STE 106
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6397
Practice Address - Country:US
Practice Address - Phone:904-641-6628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS-6584207P00000X
WV3206207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine