Healthcare Provider Details

I. General information

NPI: 1548014921
Provider Name (Legal Business Name): JOY ANN ALONZO CARLOS NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2024
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15955 PARAMOUNT BLVD STE A
PARAMOUNT CA
90723-5144
US

IV. Provider business mailing address

29220 SOUTHERNESS
LAKE ELSINORE CA
92530-4399
US

V. Phone/Fax

Practice location:
  • Phone: 562-531-9806
  • Fax:
Mailing address:
  • Phone: 310-529-6846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95023265
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: