Basic Information
Provider Information
NPI: 1871027623
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALEGRIA
FirstName: ANGIE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 501 6TH AVE S
Address2:  
City: ST PETERSBURG
State: FL
PostalCode: 337014634
CountryCode: US
TelephoneNumber: 7277674243
FaxNumber: 7277678612
Practice Location
Address1: 501 6TH AVE S
Address2:  
City: ST PETERSBURG
State: FL
PostalCode: 337014634
CountryCode: US
TelephoneNumber: 7277674243
FaxNumber: 7277678612
Other Information
ProviderEnumerationDate: 04/19/2017
LastUpdateDate: 10/11/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/11/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X FLN Student, Health CareStudent in an Organized Health Care Education/Training Program 
208M00000XOS16935FLY Allopathic & Osteopathic PhysiciansHospitalist 

No ID Information.


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