MEDICARE: KARLA ALONZO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1578760757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARLA ALONZO

Provider Business Mailing Address
First Line	:	6745 HASKELL AVE APT 5
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91406-6155
Country	:	US
Telephone Number	:	323-249-9026
Fax Number	:

Provider Business Practice Location Address
First Line	:	8042 YOLANDA AVE
Second Line	:
City	:	RESEDA
State	:	CA
Zip	:	91335-1257
Country	:	US
Telephone Number	:	818-773-9204
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2007
Last Update Date	:	07/08/2007

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Directions to “ KARLA ALONZO ” Practice Location

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