MEDICARE: GIL ALONSO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2355S0801X	Speech-Language Assistant	SI5992	FL

General Provider Information

NPI Number	:	1093598054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GIL ALONSO

Provider Business Mailing Address
First Line	:	5109 SW 87TH TER
Second Line	:
City	:	COOPER CITY
State	:	FL
Zip	:	33328-4335
Country	:	US
Telephone Number	:	954-669-6634
Fax Number	:

Provider Business Practice Location Address
First Line	:	5109 SW 87TH TER
Second Line	:
City	:	COOPER CITY
State	:	FL
Zip	:	33328-4335
Country	:	US
Telephone Number	:	954-669-6634
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2023
Last Update Date	:	08/15/2023

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Directions to “ GIL ALONSO ” Practice Location

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