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General NPI Number Information
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NPI Number | 1972134286
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Entity Type | Individual
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Provider Name | ALEXANDER BALAEZ PA-C
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Gender | Male
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Dates
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Enumeration Date | 01/27/2020
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Last Update Date | 01/27/2022
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Provider Practice Location Address
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Address Line | 7400 SW 87TH AVE STE 100
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City | MIAMI
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State | FL
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Zip | 33173-5458
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Country | US
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Telephone | 305-412-5781
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Fax |
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Provider Business Mailing Address
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Address Line | 3630 SW 104TH CT
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City | MIAMI
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State | FL
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Zip | 33165-3720
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Country | US
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Telephone | 786-376-3621
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 9112981
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License Number State | FL
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