Provider Demographics
NPI:1619405891
Name:GONZALEZ ALFONZO, ALVARO JORGE (MD)
Entity Type:Individual
Prefix:
First Name:ALVARO
Middle Name:JORGE
Last Name:GONZALEZ ALFONZO
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 1:900 CARILLON PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-1108
Mailing Address - Country:US
Mailing Address - Phone:727-519-2760
Mailing Address - Fax:727-333-6384
Practice Address - Street 1:900 CARILLON PKWY STE 200
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-1108
Practice Address - Country:US
Practice Address - Phone:727-519-2760
Practice Address - Fax:727-333-6384
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME1502792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program