Healthcare Provider Details

I. General information

NPI: 1184963415
Provider Name (Legal Business Name): JUAN CARLOS ALONSO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2013
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 NURSING HOME DR STE 1
ARCADIA FL
34266-3839
US

IV. Provider business mailing address

PO BOX 25487
SARASOTA FL
34277-2487
US

V. Phone/Fax

Practice location:
  • Phone: 863-993-2966
  • Fax: 863-494-5491
Mailing address:
  • Phone: 941-867-4850
  • Fax: 877-807-0253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN1162
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: