Healthcare Provider Details

I. General information

NPI: 1114949955
Provider Name (Legal Business Name): CARMEN MARIA ALFONZO M.D.,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1495 NW 20TH ST
MIAMI FL
33142-7723
US

IV. Provider business mailing address

1495 NW 20TH ST
MIAMI FL
33142-7723
US

V. Phone/Fax

Practice location:
  • Phone: 305-549-6000
  • Fax: 305-549-6006
Mailing address:
  • Phone: 305-549-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0064631
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: