Healthcare Provider Details

I. General information

NPI: 1396600037
Provider Name (Legal Business Name): ALEJANDRO BONZON LOLO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 NW 14TH ST
MIAMI FL
33125-1703
US

IV. Provider business mailing address

3535NW 14TH ST
MIAMI FL
33125-4320
US

V. Phone/Fax

Practice location:
  • Phone: 786-783-8544
  • Fax:
Mailing address:
  • Phone: 786-793-8544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: