Provider Demographics
NPI:1194726489
Name:FENIQUITO, ALICE (MD)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:FENIQUITO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1157 S STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6101
Mailing Address - Country:US
Mailing Address - Phone:561-795-3330
Mailing Address - Fax:561-795-1030
Practice Address - Street 1:1157 S STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6101
Practice Address - Country:US
Practice Address - Phone:561-795-3330
Practice Address - Fax:561-795-1030
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
FLME29321207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD86194Medicare UPIN