Provider Demographics
NPI:1588845051
Name:SAA, ALFONSO H (MD)
Entity Type:Individual
Prefix:
First Name:ALFONSO
Middle Name:H
Last Name:SAA
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 1:508 S HABANA AVE
Mailing Address - Street 2:SUITE 255
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4181
Mailing Address - Country:US
Mailing Address - Phone:813-875-8550
Mailing Address - Fax:813-875-8402
Practice Address - Street 1:508 S HABANA AVE
Practice Address - Street 2:SUITE 255
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4181
Practice Address - Country:US
Practice Address - Phone:813-875-8550
Practice Address - Fax:813-875-8402
Is Sole Proprietor?:No
Enumeration Date:2007-11-26
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME341822084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068610700Medicaid
FLD54019Medicare UPIN
FL068610700Medicaid