Provider Demographics
NPI:1285759100
Name:ALONZO, DANA ANGEL (LMT)
Entity type:Individual
Prefix:MISS
First Name:DANA
Middle Name:ANGEL
Last Name:ALONZO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17-251 HWY 11
Mailing Address - Street 2:
Mailing Address - City:KURTISTOWN
Mailing Address - State:HI
Mailing Address - Zip Code:96760-0191
Mailing Address - Country:US
Mailing Address - Phone:808-966-5052
Mailing Address - Fax:
Practice Address - Street 1:90 KAMEHAMEHA AVE
Practice Address - Street 2:SUITE #10
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2832
Practice Address - Country:US
Practice Address - Phone:808-936-1075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI5714171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor