MEDICARE: ALEXANDER ALFONSO

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	343900000X	Non-emergency Medical Transport (VAN)	31206	FL

General Provider Information

NPI Number	:	1649748179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDER ALFONSO

Provider Business Mailing Address
First Line	:	1840 W 49TH ST STE 735
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-2824
Country	:	US
Telephone Number	:	305-603-9684
Fax Number	:

Provider Business Practice Location Address
First Line	:	1840 W 49TH ST STE 735
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-2824
Country	:	US
Telephone Number	:	305-603-9684
Fax Number	:

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

Provider Enumeration Date	:	11/02/2018
Last Update Date	:	11/02/2018

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