Provider Demographics
NPI:1821246133
Name:ELOZEGUI ALFONSO, WANDA (MD)
Entity Type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:
Last Name:ELOZEGUI 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 1:2664 TAMIAMI TRL E
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34112-5707
Mailing Address - Country:US
Mailing Address - Phone:239-428-1010
Mailing Address - Fax:239-734-6342
Practice Address - Street 1:2664 TAMIAMI TRL E
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-5707
Practice Address - Country:US
Practice Address - Phone:239-428-1010
Practice Address - Fax:239-734-6342
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME107639207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine