Provider Demographics
NPI:1417235615
Name:ALONSOLOPEZ, RICARDO ARMANDO (IDC)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:ARMANDO
Last Name:ALONSOLOPEZ
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3D MLG CLR-37, KGAS
Mailing Address - Street 2:UNIT 38404
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96604-8404
Mailing Address - Country:US
Mailing Address - Phone:315-637-1250
Mailing Address - Fax:
Practice Address - Street 1:3D MLG CLR-37, KGAS
Practice Address - Street 2:UNIT 38404
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96604-8404
Practice Address - Country:US
Practice Address - Phone:315-637-1250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-22
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman