Provider Demographics
NPI:1457066862
Name:ALONSO VALDES, GRISEMA
Entity Type:Individual
Prefix:
First Name:GRISEMA
Middle Name:
Last Name:ALONSO VALDES
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 1:790 NW 107TH AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-3100
Mailing Address - Country:US
Mailing Address - Phone:305-964-5426
Mailing Address - Fax:305-964-5627
Practice Address - Street 1:790 NW 107TH AVE STE 110
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-3100
Practice Address - Country:US
Practice Address - Phone:305-964-5426
Practice Address - Fax:305-964-5627
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor