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Provider Information for 1457526568

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

IDA DELOS SANTOS ALFONSO

Gender: FEMALE

Individual NPI: 1457526568

Calendar   Last Updated:  2008-04-29
  Certification Date: 

Details

Name Value
NPI 1457526568
Enumeration Date 2008-04-29
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 5814 VAN ALLEN WAY SUITE #205
CARLSBAD, CA 92008
United States

Phone: 760-931-0144 | Fax: 760-931-0827
View Map External Link
Primary Practice Address 5814 VAN ALLEN WAY STE 205
CARLSBAD, CA 92008-7360
United States

Phone: 760-931-0144 | Fax: 760-931-0827
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice CA 53572