Provider Demographics
NPI:1861256117
Name:ALONSO, ANTHONY ALLAN CALIMQUIM (PA-C)
Entity type:Individual
Prefix:
First Name:ANTHONY ALLAN
Middle Name:CALIMQUIM
Last Name:ALONSO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5710 SPAHN AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90713-1240
Mailing Address - Country:US
Mailing Address - Phone:562-229-8626
Mailing Address - Fax:
Practice Address - Street 1:18225 BROOKHURST ST STE 5
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6719
Practice Address - Country:US
Practice Address - Phone:714-599-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA64019363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant