Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | MD048984 | DC |
NPI | 1295118990 |
---|---|
Provider Name | Alonso Gonzalo Zea Vera |
First Address | Atlanta, GA 30374-4785 |
Second Address | Washington, DC 20010-2916 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2015 |
Last Update Date | 05/05/2021 |