Healthcare Provider Details

I. General information

NPI: 1619505492
Provider Name (Legal Business Name): ALFONSO FRANCISCO SIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2020
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 13TH ST
EVERETT WA
98201-1689
US

IV. Provider business mailing address

40 W 3RD AVE APT 903
SAN MATEO CA
94402-7117
US

V. Phone/Fax

Practice location:
  • Phone: 404-740-4807
  • Fax:
Mailing address:
  • Phone: 404-740-4807
  • Fax:

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 State
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number75236
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD.MD.70106458
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: