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General NPI Number Information
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NPI Number | 1891301271
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Entity Type | Individual
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Provider Name | CARLOS RENE ALICEA JR. SLP-A
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Gender | Male
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Dates
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Enumeration Date | 09/21/2020
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Last Update Date | 09/21/2020
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Provider Practice Location Address
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Address Line | 13574 VILLAGE PARK DR STE SUITE205
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City | ORLANDO
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State | FL
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Zip | 32837-7689
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Country | US
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Telephone | 407-789-7777
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Fax |
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Provider Business Mailing Address
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Address Line | 10349 CYPRESS TRAIL DR
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City | ORLANDO
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State | FL
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Zip | 32825-5043
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Country | US
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Telephone | 786-436-0278
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Fax |
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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 | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | 4512
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License Number State | FL
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