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General NPI Number Information
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NPI Number | 1174981245
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Entity Type | Organization
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Legal Business Name | LENUS RESEARCH & MEDICAL GROUP
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Dates
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Enumeration Date | 02/04/2016
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Last Update Date | 02/04/2016
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Provider Practice Location Address
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Address Line | 1414 NW 107TH AVE STE 214
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City | DORAL
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State | FL
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Zip | 33172-2741
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Country | US
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Telephone | 305-592-4692
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Fax |
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Provider Business Mailing Address
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Address Line | 1414 NW 107TH AVE STE 214
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City | DORAL
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State | FL
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Zip | 33172-2741
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Country | US
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Telephone | 305-592-4692
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CARLOS ENRIQUE ALONSO
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Credential | BS
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Telephone | 305-796-3325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A452-105-77-287-0
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License Number State | FL
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