Healthcare Provider Details

I. General information

NPI: 1467826503
Provider Name (Legal Business Name): DIOSALYN ALONZO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2015
Last Update Date: 01/22/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N LA BREA AVE
INGLEWOOD CA
90301-1708
US

IV. Provider business mailing address

PO BOX 357631
SEATTLE WA
98195-7631
US

V. Phone/Fax

Practice location:
  • Phone: 866-391-2678
  • Fax:
Mailing address:
  • Phone: 206-543-2030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60879754
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number89780
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: