Healthcare Provider Details

I. General information

NPI: 1255831798
Provider Name (Legal Business Name): ALEXIS VARONA SERRANO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2018
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 SW 6TH ST APT 1
MIAMI FL
33135-3446
US

IV. Provider business mailing address

1821 SW 6TH ST APT 1
MIAMI FL
33135-3446
US

V. Phone/Fax

Practice location:
  • Phone: 786-915-9531
  • Fax:
Mailing address:
  • Phone: 786-915-9531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: