Healthcare Provider Details

I. General information

NPI: 1902645120
Provider Name (Legal Business Name): VALERIA ALFARO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15332 NW 79TH CT
MIAMI LAKES FL
33016-5808
US

IV. Provider business mailing address

1958 NEWHAVEN AVE
WELLINGTON FL
33414-8074
US

V. Phone/Fax

Practice location:
  • Phone: 305-821-0304
  • Fax:
Mailing address:
  • Phone: 561-315-3269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6447
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: