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Provider Information for 1043658354

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

ALEXIS GOMEZ ALFONSO

Gender: MALE

Individual NPI: 1043658354

Calendar   Last Updated:  2020-05-22
  Certification Date:  2020-05-22

Details

Name Value
NPI 1043658354
Enumeration Date 2013-06-08
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 17920 NW 74TH CT
HIALEAH, FL 33015-8458
United States

Phone: 954-861-8349 | Fax:
View Map External Link
Primary Practice Address 17920 NW 74TH CT
HIALEAH, FL 33015-8458
United States

Phone: 954-861-8349 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 103K00000X - Behavioral Analyst