MEDICARE: DR. VICTOR JONATHAN ALONSO III PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	246ZE0500X	EEG Specialist/Technologist
2	101YP1600X	Pastoral Counselor
3	2472E0500X	EEG Technician
4	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1134424849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICTOR JONATHAN ALONSO III PH.D.

Provider Business Mailing Address
First Line	:	450 NORTH SAM HOUSTON PARKWAY
Second Line	:	SUITE156
City	:	HOUSTON
State	:	TX
Zip	:	77090-2910
Country	:	US
Telephone Number	:	713-261-2950
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 N SAM HOUSTON PKWY E
Second Line	:	SUITE 156
City	:	HOUSTON
State	:	TX
Zip	:	77060-3551
Country	:	US
Telephone Number	:	713-261-2950
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2011
Last Update Date	:	12/12/2013

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