Provider Demographics
NPI:1992512685
Name:FERNANDEZ ALFONSO, GRISELDA A
Entity type:Individual
Prefix:
First Name:GRISELDA
Middle Name:A
Last Name:FERNANDEZ ALFONSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3311 58TH ST W
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971-5888
Mailing Address - Country:US
Mailing Address - Phone:786-675-0924
Mailing Address - Fax:
Practice Address - Street 1:3311 58TH ST W
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-5888
Practice Address - Country:US
Practice Address - Phone:786-675-0924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician