Provider Demographics
NPI:1669464574
Name:ALONSO-LEJ, CHANTAL M (MD)
Entity Type:Individual
Prefix:
First Name:CHANTAL
Middle Name:M
Last Name:ALONSO-LEJ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1851 OAK LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1533
Mailing Address - Country:US
Mailing Address - Phone:321-230-3127
Mailing Address - Fax:
Practice Address - Street 1:1851 OAK LN
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1533
Practice Address - Country:US
Practice Address - Phone:321-230-3127
Practice Address - Fax:407-381-1142
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL47155208000000X
FLME47155208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL046853300Medicaid