Healthcare Provider Details

I. General information

NPI: 1669464574
Provider Name (Legal Business Name): CHANTAL M ALONSO-LEJ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 06/21/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1851 OAK LN
ORLANDO FL
32803-1533
US

IV. Provider business mailing address

1851 OAK LN
ORLANDO FL
32803-1533
US

V. Phone/Fax

Practice location:
  • Phone: 321-230-3127
  • Fax: 407-381-1142
Mailing address:
  • Phone: 321-230-3127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number47155
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME47155
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: