Provider Demographics
NPI:1598645194
Name:ALONSO ORTEGA, CARLOS JOAQUIN
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:JOAQUIN
Last Name:ALONSO ORTEGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8115 SW 12TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4325
Mailing Address - Country:US
Mailing Address - Phone:305-846-4031
Mailing Address - Fax:
Practice Address - Street 1:8115 SW 12TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4325
Practice Address - Country:US
Practice Address - Phone:305-846-4031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-04
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-455986106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician