Healthcare Provider Details

I. General information

NPI: 1750515607
Provider Name (Legal Business Name): ROSA ALONZO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2009
Last Update Date: 05/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 ANTHONY DR SUITE 3B
ANTHONY NM
88021-9346
US

IV. Provider business mailing address

6469 SEXTON LN
LAS CRUCES NM
88012-6719
US

V. Phone/Fax

Practice location:
  • Phone: 575-526-9378
  • Fax: 575-882-1879
Mailing address:
  • Phone: 575-543-8657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: