Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 14354 | CA |
NPI | 1003150129 |
---|---|
Provider Name | Dr. Maria Theresa Gozun Alfonso |
First Address | San Diego, CA 92128-4671 |
Second Address | El Cajon, CA 92020-2532 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2012 |
Last Update Date | 26/02/2013 |