Healthcare Provider Details

I. General information

NPI: 1184963415
Provider Name (Legal Business Name): JUAN CARLOS ALONSO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2013
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6221 NW 36TH STREET
MIAMI FL
33166
US

IV. Provider business mailing address

4483 N.W. 36TH STREET SUITE 120
MIAMI FL
33166
US

V. Phone/Fax

Practice location:
  • Phone: 305-871-3627
  • Fax:
Mailing address:
  • Phone: 305-888-7555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberACN1162
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: