Provider Demographics
NPI:1497420632
Name:ALDERETE, NORMA LETICIA
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:LETICIA
Last Name:ALDERETE
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 1:14624 SLOVER AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92337-7144
Mailing Address - Country:US
Mailing Address - Phone:909-436-7806
Mailing Address - Fax:
Practice Address - Street 1:14624 SLOVER AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92337-7144
Practice Address - Country:US
Practice Address - Phone:909-436-7806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver