Provider Demographics
NPI:1730453523
Name:ALLEY, CHARITO (PA-C)
Entity type:Individual
Prefix:
First Name:CHARITO
Middle Name:
Last Name:ALLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:683 DOUGLAS AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-0913
Mailing Address - Country:US
Mailing Address - Phone:407-478-1510
Mailing Address - Fax:407-478-1512
Practice Address - Street 1:683 DOUGLAS AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-0913
Practice Address - Country:US
Practice Address - Phone:407-478-1510
Practice Address - Fax:407-478-1512
Is Sole Proprietor?:No
Enumeration Date:2012-02-27
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9106054363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical