Provider Demographics
NPI:1093375669
Name:ALONZO, KATHLEEN ANNE MACAPAGAL
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANNE MACAPAGAL
Last Name:ALONZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5088 HIGHLAND VIEW AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-2037
Mailing Address - Country:US
Mailing Address - Phone:818-319-3908
Mailing Address - Fax:
Practice Address - Street 1:5088 HIGHLAND VIEW AVE APT 2
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041-2037
Practice Address - Country:US
Practice Address - Phone:818-319-3908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA242839164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse