MEDICARE: NEPHROLOGY INSTITUTE OF SOUTH FL LLC

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	207RN0300X	Nephrology Physician	ME111392	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295104776
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEPHROLOGY INSTITUTE OF SOUTH FL LLC

Provider Business Mailing Address
First Line	:	8210 SW 12TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33144-4330
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7392 NW 35TH TER STE 306
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33122-1260
Country	:	US
Telephone Number	:	786-703-4932
Fax Number	:	954-337-3776

Authorized Official
Title or Position	:	OWNER
Name	:	JAVIER EMILIO ALFONSO
Credential	:	MD
Telephone Number	:	786-703-4932

Provider Enumeration Date	:	09/15/2015
Last Update Date	:	11/10/2023

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