Provider Demographics
NPI:1700808698
Name:ALFONSO H SAA MD PA NEW CORP
Entity Type:Organization
Organization Name:ALFONSO H SAA MD PA NEW CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALFONSO
Authorized Official - Middle Name:H
Authorized Official - Last Name:SAA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-875-8550
Mailing Address - Street 1:508 S HABANA AVE
Mailing Address - Street 2:SUITE 255
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4181
Mailing Address - Country:US
Mailing Address - Phone:813-875-8550
Mailing Address - Fax:813-875-8402
Practice Address - Street 1:508 S HABANA AVE
Practice Address - Street 2:SUITE 255
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4181
Practice Address - Country:US
Practice Address - Phone:813-875-8550
Practice Address - Fax:813-875-8402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME341822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAI444Medicare PIN