Healthcare Provider Details

I. General information

NPI: 1063226132
Provider Name (Legal Business Name): LEXIE ALFONSO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14400 NW 77TH CT STE 306
MIAMI LAKES FL
33016-1592
US

IV. Provider business mailing address

14400 NW 77TH CT STE 306
MIAMI LAKES FL
33016-1592
US

V. Phone/Fax

Practice location:
  • Phone: 305-653-5155
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: