Provider Demographics
NPI:1942912837
Name:ALONSO ROMERO, LEIDY LAURA
Entity Type:Individual
Prefix:
First Name:LEIDY
Middle Name:LAURA
Last Name:ALONSO ROMERO
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 1:6545 W 26TH DR APT 23
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-2872
Mailing Address - Country:US
Mailing Address - Phone:786-872-6546
Mailing Address - Fax:
Practice Address - Street 1:6545 W 26TH DR APT 23
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-2872
Practice Address - Country:US
Practice Address - Phone:786-872-6546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-22
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-157413106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL116562000Medicaid