Provider Demographics
NPI:1851637607
Name:ALONZO, CHRISTINA (MACOM, LAC)
Entity Type:Individual
Prefix:MISS
First Name:CHRISTINA
Middle Name:
Last Name:ALONZO
Suffix:
Gender:F
Credentials:MACOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 LONGVIEW ST STE 211
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-4201
Mailing Address - Country:US
Mailing Address - Phone:512-576-4185
Mailing Address - Fax:
Practice Address - Street 1:2520 LONGVIEW ST STE 211
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-4201
Practice Address - Country:US
Practice Address - Phone:512-576-4185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-26
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01239171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist