Provider Demographics
NPI:1962401315
Name:PRECIADO, ALFONSO (MD)
Entity type:Individual
Prefix:
First Name:ALFONSO
Middle Name:
Last Name:PRECIADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 W COLONIAL DR STE 393
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-3433
Mailing Address - Country:US
Mailing Address - Phone:321-843-1378
Mailing Address - Fax:407-296-1873
Practice Address - Street 1:10000 W COLONIAL DR STE 393
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-3433
Practice Address - Country:US
Practice Address - Phone:321-843-1378
Practice Address - Fax:407-296-1873
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7953208600000X
UT6656178-1205208600000X
FLME164596208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL119599000Medicaid