MEDICARE: IVON M ALFONSO

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	367500000X	Certified Registered Nurse Anesthetist	11015765	FL

General Provider Information

NPI Number	:	1588383236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVON M ALFONSO

Provider Business Mailing Address
First Line	:	16602 SW 71ST TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33193-5533
Country	:	US
Telephone Number	:	786-338-5071
Fax Number	:

Provider Business Practice Location Address
First Line	:	16602 SW 71ST TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33193-5533
Country	:	US
Telephone Number	:	786-338-5071
Fax Number	:

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

Provider Enumeration Date	:	08/25/2022
Last Update Date	:	08/25/2022

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Directions to “ IVON M ALFONSO ” Practice Location

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