Healthcare Provider Details

I. General information

NPI: 1700268430
Provider Name (Legal Business Name): ALICIA VAN DOREN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2015
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11750 BIRD ROAD
MIAMI FL
33175
US

IV. Provider business mailing address

350 S MIAMI AVE #4114
MIAMI FL
33130
US

V. Phone/Fax

Practice location:
  • Phone: 305-222-5395
  • Fax:
Mailing address:
  • Phone: 408-204-9669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number332742
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number332742
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: