Basic Information
| Provider Information | |||||||||
| NPI: | 1003150129 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALFONSO | ||||||||
| FirstName: | MARIA THERESA | ||||||||
| MiddleName: | GOZUN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11134 RANCHO CARMEL DR | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921284671 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8586731084 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 539 PARKWAY PLZ | ||||||||
| Address2: | |||||||||
| City: | EL CAJON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920202532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194410138 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2012 | ||||||||
| LastUpdateDate: | 02/26/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 14354 | CA | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.