Provider Demographics
NPI:1407689946
Name:CONTRERAS, ALFONSO R (LPT)
Entity type:Individual
Prefix:
First Name:ALFONSO
Middle Name:R
Last Name:CONTRERAS
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 S C ST
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-7305
Mailing Address - Country:US
Mailing Address - Phone:559-942-6756
Mailing Address - Fax:
Practice Address - Street 1:303 S C ST
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-7305
Practice Address - Country:US
Practice Address - Phone:559-942-6756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-21
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42847167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician