Healthcare Provider Details

I. General information

NPI: 1346960150
Provider Name (Legal Business Name): RICKIE ALONZO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2022
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 N TENAYA WAY
LAS VEGAS NV
89128-0436
US

IV. Provider business mailing address

8604 SPLENDID LEAF CT
LAS VEGAS NV
89178-7550
US

V. Phone/Fax

Practice location:
  • Phone: 702-962-7360
  • Fax:
Mailing address:
  • Phone: 702-523-2862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number53758-TLC-1
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: