Healthcare Provider Details

I. General information

NPI: 1235136466
Provider Name (Legal Business Name): NORMA URSA ALONSO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 04/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. PONCE DE LEON 735 TORRE AUXILIO MUTUO SUITE 519
SAN JUAN PR
00917
US

IV. Provider business mailing address

AVE. PONCE DE LEON 735 TORRE AUXILIO MUTUO SUITE 519
SAN JUAN PR
00917
US

V. Phone/Fax

Practice location:
  • Phone: 787-759-5122
  • Fax: 787-753-4797
Mailing address:
  • Phone: 787-759-5122
  • Fax: 787-753-4797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number12164
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: