Provider Demographics
NPI:1891815064
Name:ALFONSO, JOSE ENRIQUE (CRT)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:ENRIQUE
Last Name:ALFONSO
Suffix:
Gender:M
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15214 SW 19TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4300
Mailing Address - Country:US
Mailing Address - Phone:305-406-3540
Mailing Address - Fax:305-406-3538
Practice Address - Street 1:7392 NW 35TH TER
Practice Address - Street 2:308
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33122-1271
Practice Address - Country:US
Practice Address - Phone:305-406-3540
Practice Address - Fax:305-406-3538
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTT4619227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified