Provider Demographics
NPI:1346377058
Name:ALONZO, MARK JUDE (OTR, L, SWC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:JUDE
Last Name:ALONZO
Suffix:
Gender:M
Credentials:OTR, L, SWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 E NAPLES ST
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-2519
Mailing Address - Country:US
Mailing Address - Phone:619-421-6083
Mailing Address - Fax:
Practice Address - Street 1:510 E NAPLES ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-2519
Practice Address - Country:US
Practice Address - Phone:619-421-6083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT916225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics