Provider Demographics
NPI:1659590941
Name:IGNACIO, ALFIE JAY (FNP)
Entity Type:Individual
Prefix:PROF
First Name:ALFIE
Middle Name:JAY
Last Name:IGNACIO
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3527 SPENCER ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-3619
Mailing Address - Country:US
Mailing Address - Phone:310-214-8096
Mailing Address - Fax:310-214-8096
Practice Address - Street 1:3527 SPENCER ST
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-3619
Practice Address - Country:US
Practice Address - Phone:310-214-8096
Practice Address - Fax:310-214-8096
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16803363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily