Provider Demographics
NPI:1790237626
Name:ALONZO, ERICA ELIZABETH (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MS
First Name:ERICA
Middle Name:ELIZABETH
Last Name:ALONZO
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11154 HURON ST STE 212
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80234-2329
Mailing Address - Country:US
Mailing Address - Phone:303-920-5161
Mailing Address - Fax:
Practice Address - Street 1:11154 HURON ST STE 212
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-2329
Practice Address - Country:US
Practice Address - Phone:303-920-5161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-26
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0004834363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant