Healthcare Provider Details

I. General information

NPI: 1588845051
Provider Name (Legal Business Name): ALFONSO H SAA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2007
Last Update Date: 12/04/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4620 N. HABANA AVE. SUITE 202
TAMPA FL
33614-7107
US

IV. Provider business mailing address

4620 N. HABANA AVE. SUITE 202
TAMPA FL
33614-7107
US

V. Phone/Fax

Practice location:
  • Phone: 813-875-8550
  • Fax: 813-875-8402
Mailing address:
  • Phone: 813-875-8550
  • Fax: 813-875-8402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberME34182
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME34182
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: