=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700978798
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. CARLOS M. ALONSO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2006
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9445 SW 40TH ST SUITE 106
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33165-4001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-480-3737
-----------------------------------------------------
Fax | 305-480-3738
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14451 SW 10TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33184-3114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-221-3774
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number | AS 2721
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------