Healthcare Provider Details

I. General information

NPI: 1992386148
Provider Name (Legal Business Name): ANDREA ALONZO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2021
Last Update Date: 01/15/2026
Certification Date: 01/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 NW 12TH AVE
MIAMI FL
33136-1005
US

IV. Provider business mailing address

1601 NW 12TH AVE
MIAMI FL
33136-1005
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-9683
  • Fax:
Mailing address:
  • Phone: 305-243-9683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME168906
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: