Theresa Mary Alonzo, RT LAB TECH
Individual provider Active NPI Clinical Medical Laboratory · Dulce, NM
NPI 1730262783 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1730262783
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Medical Laboratory 291U00000X
- Practice address
- 12000 Stone Lake Road
Dulce, NM 87528-0187 - Phone
- (505) 759-3291
- Fax
- (505) 759-3532
- NPI assigned
- Oct 23, 2006
- Reactivated
- Jun 16, 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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| DHHS/IHS/Aao/Jsu/Dulce Health Center | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Medical Laboratory | 291U00000X | NM | Yes |
Addresses
Primary practice location
12000 Stone Lake Road
Dulce, NM 87528-0187
Mailing address
PO Box 187
12000 Stone Lake Road
Dulce, NM 87528-0187
Phone (505) 759-3291
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000K3526 | Medicaid | NM | |
| HSZ196 | Other | NM | MEDICARE PART B |
Other providers in Dulce, NM
- Jacob Alexander
- Sirpa T. Autio
- Nicholas Robbert Ayres
- Katherine E Berry
- Maricela Bonilla
- Joshua Greer Carney
All providers in Dulce, NM · Clinical Medical Laboratory in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. 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.