Provider Demographics
NPI:1013114156
Name:ALFONSO, ROSSANA T (DDS)
Entity Type:Individual
Prefix:
First Name:ROSSANA
Middle Name:T
Last Name:ALFONSO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 D AVENUE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950
Mailing Address - Country:US
Mailing Address - Phone:619-470-2558
Mailing Address - Fax:619-475-0799
Practice Address - Street 1:819 D AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-3465
Practice Address - Country:US
Practice Address - Phone:619-470-2558
Practice Address - Fax:619-475-0799
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0492201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice