Provider Demographics
NPI:1851449995
Name:HENRIQUEZ, ALFONSO JESUS (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFONSO
Middle Name:JESUS
Last Name:HENRIQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3255 FOREST HILL BLVD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-5854
Mailing Address - Country:US
Mailing Address - Phone:561-275-7100
Mailing Address - Fax:561-275-7199
Practice Address - Street 1:3255 FOREST HILL BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-5854
Practice Address - Country:US
Practice Address - Phone:561-275-7100
Practice Address - Fax:561-275-7199
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98652208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL290226100Medicaid