Healthcare Provider Details

I. General information

NPI: 1134532542
Provider Name (Legal Business Name): NERY ALFONSO LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 06/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10401 BIRD RD
MIAMI FL
33165-3745
US

IV. Provider business mailing address

10401 BIRD RD
MIAMI FL
33165-3745
US

V. Phone/Fax

Practice location:
  • Phone: 305-222-2000
  • Fax:
Mailing address:
  • Phone: 305-222-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number1194747
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: