Provider Demographics
NPI:1598362550
Name:CARDOSO ALONSO, ANA IRIS
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:IRIS
Last Name:CARDOSO ALONSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 BRADLEY ST
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33405-2830
Mailing Address - Country:US
Mailing Address - Phone:561-768-6787
Mailing Address - Fax:
Practice Address - Street 1:722 BRADLEY ST
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33405-2830
Practice Address - Country:US
Practice Address - Phone:561-768-6787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB542047106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician