Provider Demographics
NPI:1770032757
Name:PERSSON, ALFRED
Entity Type:Individual
Prefix:MR
First Name:ALFRED
Middle Name:
Last Name:PERSSON
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 1:147 S JUANITA ST
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4314
Mailing Address - Country:US
Mailing Address - Phone:877-321-8294
Mailing Address - Fax:951-765-3077
Practice Address - Street 1:147 S JUANITA ST
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4314
Practice Address - Country:US
Practice Address - Phone:877-321-8294
Practice Address - Fax:951-765-3077
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-01
Last Update Date:2016-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi