Healthcare Provider Details

I. General information

NPI: 1922377167
Provider Name (Legal Business Name): BIANCA D. ALFONSO, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2011
Last Update Date: 12/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 BILTMORE WAY STE 205
CORAL GABLES FL
33134-5757
US

IV. Provider business mailing address

555 BILTMORE WAY STE 205
CORAL GABLES FL
33134-5757
US

V. Phone/Fax

Practice location:
  • Phone: 305-445-3611
  • Fax:
Mailing address:
  • Phone: 305-445-3611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME109946
License Number StateFL

VIII. Authorized Official

Name: BIANCA D ALFONSO
Title or Position: DIRECTOR
Credential: MD
Phone: 305-632-8107