Organization
ALFONSO PROFESSIONAL MEDICAL CTR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JUAN CARLOS ALFONSO MA (OWNER)
(305) 480-8473
Entity
Organization
Contact information
Practice address
11180 W FLAGLER STREET, STE 13, MIAMI, FL 33174-1215
(305) 480-8473
(305) 480-8472
Mailing address
11180 W FLAGLER ST, STE 13, MIAMI, FL 33174-1216
(305) 480-8473
(305) 480-8472
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
MA 42956
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA 42956
STATE OF FLORIDA DEPT OF HEALTH
FL
Enumeration date
05/06/2009
Last updated
05/06/2009
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