Healthcare Provider Details

I. General information

NPI: 1750157715
Provider Name (Legal Business Name): ILEANA DE LA CARIDAD ALONSO PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2023
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4175 W 20TH AVE
HIALEAH FL
33012-5874
US

IV. Provider business mailing address

7241 NW 174TH TER APT 101
HIALEAH FL
33015-1110
US

V. Phone/Fax

Practice location:
  • Phone: 305-424-3066
  • Fax:
Mailing address:
  • Phone: 786-385-4366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH22970
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: