Provider Demographics
NPI:1013635259
Name:ALEXANDRE, MONFORT (CARE TAKER)
Entity Type:Individual
Prefix:MR
First Name:MONFORT
Middle Name:
Last Name:ALEXANDRE
Suffix:
Gender:M
Credentials:CARE TAKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1762 SE CARVALHO ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-4554
Mailing Address - Country:US
Mailing Address - Phone:772-577-3861
Mailing Address - Fax:772-577-3790
Practice Address - Street 1:1762 SE CARVALHO ST
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-4554
Practice Address - Country:US
Practice Address - Phone:772-577-3861
Practice Address - Fax:772-577-3790
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL13125251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services