Provider Demographics
NPI:1093511230
Name:IGLESIAS, ALEX (EMT-B)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:IGLESIAS
Suffix:
Gender:
Credentials:EMT-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12874 SW 61ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-1398
Mailing Address - Country:US
Mailing Address - Phone:786-348-1961
Mailing Address - Fax:
Practice Address - Street 1:2665 ORTIZ AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-7812
Practice Address - Country:US
Practice Address - Phone:786-348-1961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL584732207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services