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General NPI Number Information
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NPI Number | 1376588061
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Entity Type | Individual
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Provider Name | ALFREDO DEJESUS DALLY M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 12/10/2024
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Provider Practice Location Address
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Address Line | 5511 SW 8TH ST STE 101
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City | CORAL GABLES
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State | FL
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Zip | 33134-2272
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Country | US
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Telephone | 305-269-8099
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Fax | 305-261-3250
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Provider Business Mailing Address
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Address Line | 13992 LAKE GEORGE CT
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City | MIAMI LAKES
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State | FL
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Zip | 33014-3043
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Country | US
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Telephone | 305-269-8099
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Fax | 305-261-3250
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME88433
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License Number State | FL
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