Provider Demographics
NPI:1417378316
Name:ALONZO, GLORIA
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:
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 1:30 VAN NESS AVE
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-6020
Mailing Address - Country:US
Mailing Address - Phone:415-206-8663
Mailing Address - Fax:415-206-5513
Practice Address - Street 1:995 POTRERO AVE
Practice Address - Street 2:W85, ROOM 518
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-2859
Practice Address - Country:US
Practice Address - Phone:415-206-8663
Practice Address - Fax:415-206-5513
Is Sole Proprietor?:No
Enumeration Date:2013-12-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor