Provider Demographics
NPI:1427168822
Name:BOMBINO, ALEXANDER
Entity type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:
Last Name:BOMBINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 W 26TH AVE
Mailing Address - Street 2:SUITE # 2
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-2753
Mailing Address - Country:US
Mailing Address - Phone:305-827-5470
Mailing Address - Fax:305-827-5463
Practice Address - Street 1:8001 W 26TH AVE
Practice Address - Street 2:SUITE # 2
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-2753
Practice Address - Country:US
Practice Address - Phone:305-827-5470
Practice Address - Fax:305-827-5463
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 42195225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty