Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | ME114962 | FL |
NPI | 1033298393 |
---|---|
Provider Name | Mayra I Alfonso |
First Address | Spring Hill, FL 34608-1306 |
Second Address | Bradenton, FL 34209-4602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 25/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ME114962 | FL MEDICAL LICENSE (01) | |
Q46726 | (05) | SC |