Healthcare Provider Details

I. General information

NPI: 1295468262
Provider Name (Legal Business Name): KATIUSKA BORGES ALFONSO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATIRA MILAGROS BORGES ALFONSO MD

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3108 17TH STREET UNITS A-C
ST. CLOUD FL
34769-6021
US

IV. Provider business mailing address

425 W COLONIAL DR STE 303
ORLANDO FL
32804-6863
US

V. Phone/Fax

Practice location:
  • Phone: 407-986-9642
  • Fax: 833-450-5421
Mailing address:
  • Phone: 321-758-2966
  • Fax: 407-286-4515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN1550
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number23374
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: