Healthcare Provider Details

I. General information

NPI: 1760702351
Provider Name (Legal Business Name): MERCEDES N ALONSO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2010
Last Update Date: 07/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 E 44 TH ST
HIALEAH FL
33913-1914
US

IV. Provider business mailing address

10470 W OKEECHOBEE RD APT 902
HIALEAH FL
33018-1945
US

V. Phone/Fax

Practice location:
  • Phone: 786-416-2467
  • Fax: 305-512-4143
Mailing address:
  • Phone: 786-416-2467
  • Fax: 305-512-4143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number27523
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA57303
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: