Provider Demographics
NPI:1598442238
Name:ALONSO, FLORENTINO EMMANUELLE
Entity Type:Individual
Prefix:
First Name:FLORENTINO
Middle Name:EMMANUELLE
Last Name:ALONSO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19820 NW 47TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-1713
Mailing Address - Country:US
Mailing Address - Phone:786-202-1414
Mailing Address - Fax:
Practice Address - Street 1:18480 NW 19TH ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-3823
Practice Address - Country:US
Practice Address - Phone:786-376-5812
Practice Address - Fax:954-416-7373
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-04
Last Update Date:2023-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB920198106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician