Provider Demographics
NPI:1740240050
Name:ALFONSO, YAZMIN (MD)
Entity Type:Individual
Prefix:
First Name:YAZMIN
Middle Name:
Last Name:ALFONSO
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 1:3601 W COMMERCIAL BLVD STE 5
Mailing Address - Street 2:ANESCO NORTH BROWARD LLC
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309
Mailing Address - Country:US
Mailing Address - Phone:954-485-5666
Mailing Address - Fax:954-484-1651
Practice Address - Street 1:C/O CORAL SPRINGS MEDICAL CENTER
Practice Address - Street 2:3000 CORAL HILLS DRIVE
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065
Practice Address - Country:US
Practice Address - Phone:954-344-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86225207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267283900Medicaid
FLH87450Medicare UPIN
FL267283900Medicaid