=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629234349
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALONZO ALI NASSIFF C.N.I.M.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2008
-----------------------------------------------------
Last Update Date | 08/01/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3621 GULL AVE
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78504-4788
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-739-5670
-----------------------------------------------------
Fax | 956-698-6117
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3621 GULL AVENUE
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78504-4788
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-739-5670
-----------------------------------------------------
Fax | 956-698-6117
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246ZE0600X
-----------------------------------------------------
Taxonomy Name | Electroneurodiagnostic Specialist/Technologist
-----------------------------------------------------
License Number | 492
-----------------------------------------------------
License Number State |
-----------------------------------------------------