Provider Demographics
NPI:1821334897
Name:MONTERO, ALFONSO (LVN)
Entity Type:Individual
Prefix:MR
First Name:ALFONSO
Middle Name:
Last Name:MONTERO
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5822 HAZEL AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGEVALE
Mailing Address - State:CA
Mailing Address - Zip Code:95662-4512
Mailing Address - Country:US
Mailing Address - Phone:916-988-1146
Mailing Address - Fax:916-348-7468
Practice Address - Street 1:5822 HAZEL AVE
Practice Address - Street 2:
Practice Address - City:ORANGEVALE
Practice Address - State:CA
Practice Address - Zip Code:95662-4512
Practice Address - Country:US
Practice Address - Phone:916-988-1146
Practice Address - Fax:916-348-7468
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA162670164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse