Provider Demographics
NPI:1376351114
Name:ALONSO MARRERO, JUAN C (SLPA)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:C
Last Name:ALONSO MARRERO
Suffix:
Gender:M
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18965 NW 62ND AVE APT 111
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5056
Mailing Address - Country:US
Mailing Address - Phone:786-355-0653
Mailing Address - Fax:
Practice Address - Street 1:18965 NW 62ND AVE APT 111
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5056
Practice Address - Country:US
Practice Address - Phone:786-355-0653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6057235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist