Provider Demographics
NPI:1194761056
Name:NOLASCO-ALONZO, SUSANA SANTIAGO (MD)
Entity type:Individual
Prefix:MRS
First Name:SUSANA
Middle Name:SANTIAGO
Last Name:NOLASCO-ALONZO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:SUSANA
Other - Middle Name:NOLASCO
Other - Last Name:ALONZO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2926 MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-1362
Mailing Address - Country:US
Mailing Address - Phone:510-791-8010
Mailing Address - Fax:
Practice Address - Street 1:1251 W TENNYSON RD
Practice Address - Street 2:#5
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-4400
Practice Address - Country:US
Practice Address - Phone:510-782-7116
Practice Address - Fax:510-782-4574
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38527208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics