Provider Demographics
NPI:1790314508
Name:CONFESOR, ALFREDO G JR (N/A)
Entity Type:Individual
Prefix:MR
First Name:ALFREDO
Middle Name:G
Last Name:CONFESOR
Suffix:JR
Gender:M
Credentials:N/A
Other - Prefix:MR
Other - First Name:ALFREDO
Other - Middle Name:G
Other - Last Name:CONFESOR
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:NURSING GRADUATE
Mailing Address - Street 1:27082 ONEILL DR APT 233
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-0975
Mailing Address - Country:US
Mailing Address - Phone:760-575-6701
Mailing Address - Fax:
Practice Address - Street 1:27082 ONEILL DR APT 233
Practice Address - Street 2:
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-0975
Practice Address - Country:US
Practice Address - Phone:760-575-6701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7512081770374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF4471145OtherLICENCE NUMBER