Healthcare Provider Details

I. General information

NPI: 1942926308
Provider Name (Legal Business Name): ENAK ALFONSO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2022
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8777 SAN JOSE BLVD STE 701
JACKSONVILLE FL
32217-4292
US

IV. Provider business mailing address

7738 A C SKINNER PKWY APT 6305
JACKSONVILLE FL
32256-8159
US

V. Phone/Fax

Practice location:
  • Phone: 904-733-8255
  • Fax:
Mailing address:
  • Phone: 321-507-7965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ10870
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: