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General NPI Number Information
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NPI Number | 1396040085
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Entity Type | Individual
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Provider Name | JORGE E ALFONSO
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Gender | Male
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Dates
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Enumeration Date | 01/11/2011
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Last Update Date | 05/29/2025
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Provider Practice Location Address
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Address Line | 30 PROFESSIONAL CENTER PKWY
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City | SAN RAFAEL
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State | CA
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Zip | 94903-2757
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Country | US
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Telephone | 415-652-4376
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Fax | 415-652-4376
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Provider Business Mailing Address
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Address Line | 8945 GOLF LINKS RD
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City | OAKLAND
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State | CA
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Zip | 94605-4124
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Country | US
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Telephone | 510-317-1444
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number |
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License Number State |
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