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

Table of content: DR. GEORGE WAYNE HALTOM III DDS (NPI 1619051968)

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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