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Alpha Journal
NPI 1396162889 · on the registry since 2014 · sole proprietor
Practice
- Address
- 2115 Se Lennard Rd
Port St Lucie, FL 34952 - Phone
- (772) 335-1812
- Fax
- (772) 335-1825
- Clinicians at this address
- 2
Registry record
- Primary taxonomy
- 363A00000X
363A00000X
- Licence states on file
- FL
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2014-05-16
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Florida