=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346360369
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ORLANDO ALFONSO M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2007
-----------------------------------------------------
Last Update Date | 12/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5190 NW 167TH ST STE 109
-----------------------------------------------------
City | MIAMI LAKES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33014-6329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-851-2860
-----------------------------------------------------
Fax | 786-796-0930
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7080 SW 107TH ST
-----------------------------------------------------
City | PINECREST
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33156-3587
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-374-4329
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | ME103044
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------