Provider Demographics
NPI:1003132333
Name:ALONZO, JASON (IDMT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:ALONZO
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13136 EL RIO RD
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-8676
Mailing Address - Country:US
Mailing Address - Phone:937-474-3352
Mailing Address - Fax:
Practice Address - Street 1:13136 EL RIO RD
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-8676
Practice Address - Country:US
Practice Address - Phone:937-474-3352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians