Provider Demographics
NPI:1649337007
Name:ALONSO, HECTOR M SR
Entity type:Individual
Prefix:
First Name:HECTOR
Middle Name:M
Last Name:ALONSO
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 688
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-0688
Mailing Address - Country:US
Mailing Address - Phone:787-832-2045
Mailing Address - Fax:787-834-4301
Practice Address - Street 1:103 SOUTH RAMON EMETERIO BETANCES STREET
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-265-6630
Practice Address - Fax:787-834-4301
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2500183500000X
PR1287160001332B00000X
PR07-F06963336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1287160001Medicare NSC