Basic Information
| Provider Information | |||||||||
| NPI: | 1114434719 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALONSO | ||||||||
| FirstName: | ALICIA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | HAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9911 W OKEECHOBEE RD | ||||||||
| Address2: | |||||||||
| City: | HIALEAH GARDENS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330163100 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 350 W 49TH ST | ||||||||
| Address2: | |||||||||
| City: | HIALEAH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330123716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055585561 | ||||||||
| FaxNumber: | 3055583041 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2018 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | 5301 | FL | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
ID Information
| ID | Type | State | Issuer | Description | 0 | 05 | FL | MEDICAID |