Provider Demographics
NPI:1679245237
Name:ALFONSO, DARWIN RYAN ESPINO
Entity Type:Individual
Prefix:MR
First Name:DARWIN RYAN
Middle Name:ESPINO
Last Name:ALFONSO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3612 ASTRAL DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-3508
Mailing Address - Country:US
Mailing Address - Phone:650-892-4148
Mailing Address - Fax:
Practice Address - Street 1:3612 ASTRAL DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-3508
Practice Address - Country:US
Practice Address - Phone:650-892-4148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA693296314000000X, 164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility