Provider Demographics
NPI:1790923050
Name:ALONSO, WILFREDO (MD)
Entity Type:Individual
Prefix:
First Name:WILFREDO
Middle Name:
Last Name:ALONSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 LLANO JIMENEZ
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-5307
Mailing Address - Country:US
Mailing Address - Phone:787-234-5434
Mailing Address - Fax:787-882-9901
Practice Address - Street 1:LOBBY BUEN SAMARITANO
Practice Address - Street 2:AVENUE SEVERIANO CUEVAS 18
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-5307
Practice Address - Country:US
Practice Address - Phone:787-882-9900
Practice Address - Fax:787-882-9901
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-25
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17417207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRCT763AMedicare PIN