Provider Demographics
NPI:1598160004
Name:ALONSO, RAFAEL JR (PA-C)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:ALONSO
Suffix:JR
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:2050 S BLOSSER RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-7310
Mailing Address - Country:US
Mailing Address - Phone:805-361-8030
Mailing Address - Fax:805-361-8097
Practice Address - Street 1:4723 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GUADALUPE
Practice Address - State:CA
Practice Address - Zip Code:93434-1787
Practice Address - Country:US
Practice Address - Phone:805-343-5577
Practice Address - Fax:805-343-5578
Is Sole Proprietor?:No
Enumeration Date:2014-10-27
Last Update Date:2022-09-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA52072363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant