Provider Demographics
NPI:1982084539
Name:ALONSO, JUAN ANTONIO ZARAGOZA
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:ANTONIO ZARAGOZA
Last Name:ALONSO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JUAN
Other - Middle Name:ANTONIO
Other - Last Name:ALONSO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2522
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92202-3322
Mailing Address - Country:US
Mailing Address - Phone:760-609-5572
Mailing Address - Fax:
Practice Address - Street 1:1612 1ST ST
Practice Address - Street 2:
Practice Address - City:COACHELLA
Practice Address - State:CA
Practice Address - Zip Code:92236-1407
Practice Address - Country:US
Practice Address - Phone:760-398-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-08
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1123071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical