Basic Information
| Provider Information | |||||||||
| NPI: | 1770598641 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALZUGARAY | ||||||||
| FirstName: | SERGIO | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 351597 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331357597 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054435031 | ||||||||
| FaxNumber: | 3054431336 | ||||||||
| Practice Location | |||||||||
| Address1: | 2140 W 68TH ST | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | HIALEAH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330161815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3058283997 | ||||||||
| FaxNumber: | 3058284696 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2006 | ||||||||
| LastUpdateDate: | 08/16/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | ME73697 | FL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 253617000 | 05 | FL | MEDICAID |