1588632160 NPI number — MR. ALONSO FERNANDEZ M.D.

Table of content: MR. ALONSO FERNANDEZ M.D. (NPI 1588632160)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588632160 NPI number — MR. ALONSO FERNANDEZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERNANDEZ
Provider First Name:
ALONSO
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588632160
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12171 SW 268TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOMESTEAD
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33032-8001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-278-0200
Provider Business Mailing Address Fax Number:
305-851-4110

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLE GLADE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33430-4998
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-992-4357
Provider Business Practice Location Address Fax Number:
561-952-1805
Provider Enumeration Date:
03/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  M0403 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: ME106360 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 171756301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8S0882 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 108276300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com