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IDA DELOS SANTOS ALFONSO
General Practice >> Dentist >> Dental ProvidersRegistrant NPI Number: 1457526568
Individual Registrant: IDA DELOS SANTOS ALFONSO
Gender: F
Sole Proprietor
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
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
Tel: 760-931-0144 Fax: 760-931-0827
Registration Information:
NPI: 1457526568
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 1223G0001X | Dental Providers Dentist General Practice | CA | 53572 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
