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General NPI Number Information
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NPI Number | 1992667661
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Entity Type | Individual
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Provider Name | ALEXANDER MATTHEW AJAN PANEQUE
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Gender | Male
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Dates
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Enumeration Date | 12/01/2025
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 220 WASHINGTON AVE
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City | HOMESTEAD
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State | FL
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Zip | 33030-6034
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Country | US
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Telephone | 305-704-0313
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Fax |
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Provider Business Mailing Address
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Address Line | 18631 NW 49TH CT
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City | OPA LOCKA
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State | FL
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Zip | 33055-2402
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Country | US
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Telephone |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT44058
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License Number State | FL
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