Healthcare Provider Details

I. General information

NPI: 1316570468
Provider Name (Legal Business Name): ALEJANDRA PEREZ FONSECA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2020
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15648 SW 127TH AVE APT 207
MIAMI FL
33177-1435
US

IV. Provider business mailing address

15648 SW 127TH AVE APT 207
MIAMI FL
33177-1435
US

V. Phone/Fax

Practice location:
  • Phone: 786-222-3513
  • Fax:
Mailing address:
  • Phone: 786-222-3513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-88790
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: