Provider Demographics
NPI:1306953641
Name:ALONSO, GLADYS Y (MD)
Entity type:Individual
Prefix:
First Name:GLADYS
Middle Name:Y
Last Name:ALONSO
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 1:1840 W 49TH ST STE 514
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2950
Mailing Address - Country:US
Mailing Address - Phone:305-824-0224
Mailing Address - Fax:305-824-0727
Practice Address - Street 1:1840 W 49TH ST STE 514
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2950
Practice Address - Country:US
Practice Address - Phone:305-824-0224
Practice Address - Fax:305-824-0727
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0067595208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377186500Medicaid
FL26534Medicare PIN
FL26534Medicare ID - Type Unspecified
FL377186500Medicaid