Provider Demographics
NPI:1588620470
Name:ALONSO, LEONARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONARDO
Middle Name:
Last Name:ALONSO
Suffix:
Gender:M
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:PO BOX 144277
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33114-4277
Mailing Address - Country:US
Mailing Address - Phone:305-547-2011
Mailing Address - Fax:305-547-2099
Practice Address - Street 1:719 NW 13TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3724
Practice Address - Country:US
Practice Address - Phone:305-547-2011
Practice Address - Fax:305-547-2099
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME542392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL08245XMedicaid
C08792Medicare UPIN
FL08245XMedicaid