1891301271 NPI number — MR. CARLOS RENE ALICEA JR. SLP-A

Table of content: MR. CARLOS RENE ALICEA JR. SLP-A (NPI 1891301271)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891301271 NPI number — MR. CARLOS RENE ALICEA JR. SLP-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALICEA
Provider First Name:
CARLOS
Provider Middle Name:
RENE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
SLP-A
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:
1891301271
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10349 CYPRESS TRAIL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32825-5043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-436-0278
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13574 VILLAGE PARK DR STE SUITE205
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32837-7689
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-789-7777
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/21/2020

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: 2355S0801X , with the licence number:  4512 , 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)





Copyright © 2007-2025 www.npivalidator.com