Provider Demographics
NPI:1760702351
Name:ALONSO, MERCEDES N
Entity Type:Individual
Prefix:
First Name:MERCEDES
Middle Name:N
Last Name:ALONSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10470 W OKEECHOBEE RD APT 902
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-1945
Mailing Address - Country:US
Mailing Address - Phone:786-416-2467
Mailing Address - Fax:305-512-4143
Practice Address - Street 1:580 E 44 TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33913-1914
Practice Address - Country:US
Practice Address - Phone:786-416-2467
Practice Address - Fax:305-512-4143
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-04
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA57303225700000X
FL27523225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist