Individual
THERESA MARY ALONZO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RT LAB TECH
Contact information
Practice address
12000 STONE LAKE ROAD, DULCE, NM 87528-0187
(505) 759-3291
(505) 759-3532
Mailing address
PO BOX 187, 12000 STONE LAKE ROAD, DULCE, NM 87528-0187
(505) 759-3291
(505) 759-3532
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000K3526
—
NM
01
—
HSZ196
MEDICARE PART B
NM
Enumeration date
10/23/2006
Last updated
07/21/2022
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