MEDICARE: MAYRA I ALFONSO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	ME114962	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	ME114962	OTHER	FL MEDICAL LICENSE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033298393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYRA I ALFONSO MD

Provider Business Mailing Address
First Line	:	8221 NADMAR AVE
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33434-6306
Country	:	US
Telephone Number	:	727-748-7860
Fax Number	:

Provider Business Practice Location Address
First Line	:	4847 DAVID S MACK DR
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33417-8023
Country	:	US
Telephone Number	:	561-687-4958
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	10/21/2025

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