1194761056 NPI number — MRS. SUSANA SANTIAGO NOLASCO-ALONZO MD

Table of content: MRS. SUSANA SANTIAGO NOLASCO-ALONZO MD (NPI 1194761056)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194761056 NPI number — MRS. SUSANA SANTIAGO NOLASCO-ALONZO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NOLASCO-ALONZO
Provider First Name:
SUSANA
Provider Middle Name:
SANTIAGO
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALONZO
Provider Other First Name:
SUSANA
Provider Other Middle Name:
NOLASCO
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1194761056
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2926 MOUNTAIN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREMONT
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94555-1362
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-791-8010
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1251 W TENNYSON RD
Provider Second Line Business Practice Location Address:
#5
Provider Business Practice Location Address City Name:
HAYWARD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94544-4400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-782-7116
Provider Business Practice Location Address Fax Number:
510-782-4574
Provider Enumeration Date:
06/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  A38527 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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