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IDA DELOS SANTOS ALFONSO

General Practice >> Dentist >> Dental Providers

Registrant NPI Number: 1457526568

Individual Registrant:
 IDA DELOS SANTOS ALFONSO 
Gender: F
Sole Proprietor

Location and contact information for practice:
5814 VAN ALLEN WAY STE 205  CARLSBAD, CA 92008-7360 US
Tel: 760-931-0144  Fax: 760-931-0827

Contact information for business:
5814 VAN ALLEN WAY SUITE #205 CARLSBAD, CA 92008 US
Tel: 760-931-0144  Fax: 760-931-0827

Registration Information:
NPI: 1457526568
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y1223G0001XDental Providers
Dentist
General Practice
CA53572

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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