Provider Demographics
NPI:1811262413
Name:ALCORTA, ANTONIO (BCO)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:ALCORTA
Suffix:
Gender:M
Credentials:BCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4926 E YALE AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-1561
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2155 W MARCH LN
Practice Address - Street 2:SUITE 3F
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6420
Practice Address - Country:US
Practice Address - Phone:209-477-6352
Practice Address - Fax:559-252-1781
Is Sole Proprietor?:No
Enumeration Date:2012-03-14
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularist