Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0001X | Dental Public Health | DN13023 | FL |
Y | 1223P0221X | Pediatric Dentist | DN13023 | FL |
NPI | 1508980871 |
---|---|
Provider Name | Dr. Lidia Alonso |
First Address | Fort Lauderdale, FL 33309-3763 |
Second Address | Fort Lauderdale, FL 33316-2619 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 20/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
075414500 | (05) | FL |