Provider Demographics
NPI:1346550431
Name:BRIBIESCA, ALONSO
Entity Type:Individual
Prefix:
First Name:ALONSO
Middle Name:
Last Name:BRIBIESCA
Suffix:
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 1:609 W BAYLESS ST
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-3423
Mailing Address - Country:US
Mailing Address - Phone:626-969-6121
Mailing Address - Fax:
Practice Address - Street 1:13177 RAMONA BLVD
Practice Address - Street 2:STE. C
Practice Address - City:IRWINDALE
Practice Address - State:CA
Practice Address - Zip Code:91706-3855
Practice Address - Country:US
Practice Address - Phone:626-960-4020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner