Ida Delos Santos Alfonso
Individual provider Active NPI General Practice Dentistry · Carlsbad, CA
NPI 1457526568 · NPPES record last updated Apr 29, 2008
Key facts
- NPI
- 1457526568
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 53572 (CA)
- Practice address
- 5814 Van Allen Way Ste 205
Carlsbad, CA 92008-7360 - Phone
- (760) 931-0144
- Fax
- (760) 931-0827
- NPI assigned
- Apr 29, 2008
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 53572 | CA | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ida Alfonso DMD Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 53572 | CA | Yes |
Addresses
Primary practice location
5814 Van Allen Way Ste 205
Carlsbad, CA 92008-7360
Mailing address
5814 Van Allen Way
Suite #205
Carlsbad, CA 92008
Phone (760) 931-0144
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- Lana Elaine Alexander
- Sandra R Alexander
- Sandra Alfaro
- Derrick Algoso
- Elizabeth A Ali
- Jennifer Aliano
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- Farhonda Alizada
All providers in Carlsbad, CA · General Practice Dentistry in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 29, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.