Provider Demographics
NPI:1447528435
Name:ALZUGARAY, BORIS
Entity type:Individual
Prefix:MR
First Name:BORIS
Middle Name:
Last Name:ALZUGARAY
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 1:6595 NW 36TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:VIRGINIA GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6979
Mailing Address - Country:US
Mailing Address - Phone:305-874-3881
Mailing Address - Fax:305-526-2042
Practice Address - Street 1:6595 NW 36TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:VIRGINIA GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33166-6979
Practice Address - Country:US
Practice Address - Phone:305-874-3881
Practice Address - Fax:305-526-2042
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM28235171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMM28235OtherSTATE LICENSE