Provider Demographics
NPI:1639460033
Name:ALF PODIATRY CARE, LLC
Entity Type:Organization
Organization Name:ALF PODIATRY CARE, LLC
Other - Org Name:HOME PODIATRY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROSAS-GUYON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:305-854-2222
Mailing Address - Street 1:631 SW 23RD RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33129-1929
Mailing Address - Country:US
Mailing Address - Phone:305-854-2222
Mailing Address - Fax:305-854-8581
Practice Address - Street 1:631 SW 23RD RD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33129-1929
Practice Address - Country:US
Practice Address - Phone:305-854-2222
Practice Address - Fax:305-854-8581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-20
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2583213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPO 2583OtherPODIATRY LICENSE
FL390346001Medicaid
FL390346001Medicaid