Healthcare Provider Details

I. General information

NPI: 1497677843
Provider Name (Legal Business Name): ASHLEY MARIE ALFONSO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3122 COMMERCE PKWY
MIRAMAR FL
33025-3943
US

IV. Provider business mailing address

1500 S DOUGLAS RD
CORAL GABLES FL
33134-4108
US

V. Phone/Fax

Practice location:
  • Phone: 754-704-6111
  • Fax:
Mailing address:
  • Phone: 786-933-6274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-547660
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: