Provider Demographics
NPI:1437479821
Name:CARLOS, ALFONSO
Entity type:Individual
Prefix:MR
First Name:ALFONSO
Middle Name:
Last Name:CARLOS
Suffix:
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 1:1102 COMMERICAL AVE #1
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78211
Mailing Address - Country:US
Mailing Address - Phone:210-977-8400
Mailing Address - Fax:210-977-8401
Practice Address - Street 1:1102 COMMERCIAL AVE # 1
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78211-1752
Practice Address - Country:US
Practice Address - Phone:210-977-8400
Practice Address - Fax:210-977-8401
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX320309673332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies