Healthcare Provider Details

I. General information

NPI: 1669840864
Provider Name (Legal Business Name): AMY TRUONG ALFARO D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2015
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CHILD ST
JACKSONVILLE FL
32214-5005
US

IV. Provider business mailing address

10991 LOTTA CT
SAN DIEGO CA
92126-1171
US

V. Phone/Fax

Practice location:
  • Phone: 904-542-7130
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number64719
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: