MEDICARE: DR. CAROL ANN ALONSO M.D.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	N4898	TX

General Provider Information

NPI Number	:	1386962256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROL ANN ALONSO M.D.

Provider Business Mailing Address
First Line	:	1056 S 88TH ST STE 210
Second Line	:
City	:	LOUISVILLE
State	:	CO
Zip	:	80027-9460
Country	:	US
Telephone Number	:	303-442-6647
Fax Number	:	303-442-6647

Provider Business Practice Location Address
First Line	:	905 W 124TH AVE STE 170
Second Line	:
City	:	WESTMINSTER
State	:	CO
Zip	:	80234-1716
Country	:	US
Telephone Number	:	303-442-6647
Fax Number	:

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

Provider Enumeration Date	:	05/17/2010
Last Update Date	:	06/02/2022

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