Provider Demographics
NPI:1073051439
Name:ALONSO, JULIO CESAR I
Entity Type:Individual
Prefix:MR
First Name:JULIO
Middle Name:CESAR
Last Name:ALONSO
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2137 VALLEJO ST
Mailing Address - Street 2:2137 VALLEJO ST
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-2237
Mailing Address - Country:US
Mailing Address - Phone:323-536-4342
Mailing Address - Fax:324-325-4477
Practice Address - Street 1:2137 VALLEJO ST
Practice Address - Street 2:2137 VALLEJO ST
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90031-2237
Practice Address - Country:US
Practice Address - Phone:323-536-4342
Practice Address - Fax:233-554-5655
Is Sole Proprietor?:No
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDA87104126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant