Provider Demographics
NPI:1194297143
Name:INNOVATION PODIATRY AESTHETIC & REGENERATIVE MEDICINE PLLC
Entity type:Organization
Organization Name:INNOVATION PODIATRY AESTHETIC & REGENERATIVE MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:VALERIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALFANO GUERRIERO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:407-668-8833
Mailing Address - Street 1:1117 ASTURIA AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-4733
Mailing Address - Country:US
Mailing Address - Phone:407-668-8833
Mailing Address - Fax:
Practice Address - Street 1:209 NE 95TH ST STE 6
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-2745
Practice Address - Country:US
Practice Address - Phone:407-668-8833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-31
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1497225379Medicaid