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General NPI Number Information
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NPI Number | 1457526568
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Entity Type | Individual
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Provider Name | IDA DELOS SANTOS ALFONSO
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Gender | Female
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Dates
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Enumeration Date | 04/29/2008
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Last Update Date | 04/29/2008
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Provider Practice Location Address
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Address Line | 5814 VAN ALLEN WAY STE 205
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City | CARLSBAD
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State | CA
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Zip | 92008-7360
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Country | US
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Telephone | 760-931-0144
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Fax | 760-931-0827
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Provider Business Mailing Address
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Address Line | 5814 VAN ALLEN WAY SUITE #205
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City | CARLSBAD
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State | CA
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Zip | 92008
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Country | US
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Telephone | 760-931-0144
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Fax | 760-931-0827
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 53572
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License Number State | CA
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