Provider Demographics
NPI:1730788977
Name:ALFONZO, REBECCA SUE (NP-C)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:SUE
Last Name:ALFONZO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15791 BEAR VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-1746
Mailing Address - Country:US
Mailing Address - Phone:760-949-1231
Mailing Address - Fax:
Practice Address - Street 1:15791 BEAR VALLEY RD
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-1746
Practice Address - Country:US
Practice Address - Phone:760-949-1231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015713363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily