Provider Demographics
NPI:1174019210
Name:ALONSO, ANGELICA (MD)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:
Last Name:ALONSO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 N EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-3456
Mailing Address - Country:US
Mailing Address - Phone:909-988-2555
Mailing Address - Fax:909-460-6600
Practice Address - Street 1:741 S ALVARADO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-4021
Practice Address - Country:US
Practice Address - Phone:213-413-6666
Practice Address - Fax:213-351-9504
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-02
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA174791207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine