Healthcare Provider Details

I. General information

NPI: 1639419377
Provider Name (Legal Business Name): MARIO FRIEDRICH ALFARO RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2013
Last Update Date: 02/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 37TH ST
SACRAMENTO CA
95816-5415
US

IV. Provider business mailing address

1125 37TH ST
SACRAMENTO CA
95816-5415
US

V. Phone/Fax

Practice location:
  • Phone: 719-250-4517
  • Fax:
Mailing address:
  • Phone: 719-250-4517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number785815
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: