Individual
TERESITA ALONZO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6632 TRAILRIDE N, MILTON, FL 32570-3278
(850) 626-4897
Mailing address
6632 TRAILRIDE N, MILTON, FL 32570-3278
(850) 626-4897
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
6905409
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
141427500
—
FL
Enumeration date
08/09/2013
Last updated
08/09/2013
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