Provider Demographics
NPI:1821505348
Name:ALONSO, ABEL
Entity Type:Individual
Prefix:
First Name:ABEL
Middle Name:
Last Name:ALONSO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8850 NW 97TH AVE APT 214
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2597
Mailing Address - Country:US
Mailing Address - Phone:786-294-4924
Mailing Address - Fax:
Practice Address - Street 1:8850 NW 97TH AVE APT 214
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-2597
Practice Address - Country:US
Practice Address - Phone:786-294-4924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-05
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-311124106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician