Provider Demographics
NPI:1801804752
Name:ALEN, ZOILA M (MD)
Entity type:Individual
Prefix:
First Name:ZOILA
Middle Name:M
Last Name:ALEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7802 NW 165TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-3415
Mailing Address - Country:US
Mailing Address - Phone:305-409-7803
Mailing Address - Fax:786-536-9847
Practice Address - Street 1:2100 W 76TH ST FL 5
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5539
Practice Address - Country:US
Practice Address - Phone:786-536-9719
Practice Address - Fax:786-536-9830
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59832208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020124700Medicaid
FL020124700Medicaid
FL12178Medicare ID - Type Unspecified