Healthcare Provider Details

I. General information

NPI: 1700548864
Provider Name (Legal Business Name): JENIA YISSEL ALONSO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2021
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9671 KENORA LN
SPRING VALLEY CA
91977-2902
US

IV. Provider business mailing address

4950 WARING RD STE 4
SAN DIEGO CA
92120-2700
US

V. Phone/Fax

Practice location:
  • Phone: 619-741-8006
  • Fax:
Mailing address:
  • Phone: 619-660-3886
  • Fax: 619-660-6604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: