Provider Demographics
NPI:1043535388
Name:ALONZO, PEARL A (RN)
Entity Type:Individual
Prefix:MRS
First Name:PEARL
Middle Name:A
Last Name:ALONZO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:PINEHILL
Mailing Address - State:NM
Mailing Address - Zip Code:87357-0310
Mailing Address - Country:US
Mailing Address - Phone:505-775-3271
Mailing Address - Fax:505-775-3633
Practice Address - Street 1:BIA 125
Practice Address - Street 2:PINE HILL HEALTH CENTER
Practice Address - City:PINE HILL
Practice Address - State:NM
Practice Address - Zip Code:87357
Practice Address - Country:US
Practice Address - Phone:505-775-3271
Practice Address - Fax:505-775-3633
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR41899163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM321845Medicare PIN