Individual
DR. ANTONIO ANDREW ALFONSO JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
732 MOTT ST # 100-110, SAN FERNANDO, CA 91340-4237
(818) 963-5690
Mailing address
732 MOTT ST # 100-110, SAN FERNANDO, CA 91340-4237
(818) 963-5690
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
63500
CA
1223G0001X
General Practice Dentistry
63500
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
63500
—
CA
Enumeration date
06/25/2014
Last updated
04/21/2020
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