Provider Demographics
NPI:1750509360
Name:ALONSO & ALONSO MD PA
Entity Type:Organization
Organization Name:ALONSO & ALONSO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAISY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALONSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-547-2011
Mailing Address - Street 1:719 NW 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-3724
Mailing Address - Country:US
Mailing Address - Phone:305-547-2011
Mailing Address - Fax:305-547-2099
Practice Address - Street 1:719 NW 13TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3724
Practice Address - Country:US
Practice Address - Phone:305-547-2011
Practice Address - Fax:305-547-2099
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALONSO & ALONSO MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-22
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253984500Medicaid
FL39651Medicare ID - Type Unspecified