Provider Demographics
NPI:1841067493
Name:ALONSO, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:ALONSO
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 1:17882 SW 107TH AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-5177
Mailing Address - Country:US
Mailing Address - Phone:786-414-9224
Mailing Address - Fax:
Practice Address - Street 1:17882 SW 107TH AVE APT 5
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-5177
Practice Address - Country:US
Practice Address - Phone:786-414-9224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRBT-23-310290Medicaid