Teresita Alonzo
Individual provider Active NPI Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Milton, FL
NPI 1306279666 · NPPES record last updated Aug 9, 2013
Key facts
- NPI
- 1306279666
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X
- License
- 6905409 (FL)
- Practice address
- 6632 Trailride N
Milton, FL 32570-3278 - Phone
- (850) 626-4897
- NPI assigned
- Aug 9, 2013
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6905409 | FL | MD | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | 320900000X | 6905409 | FL | Yes |
Addresses
Primary practice location
6632 Trailride N
Milton, FL 32570-3278
Mailing address
6632 Trailride N
Milton, FL 32570-3278
Phone (850) 626-4897
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 141427500 | Medicaid | FL |
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- Mary Amir
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All providers in Milton, FL · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 9, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.