Provider Demographics
NPI:1487915898
Name:ALFARO, ANTONIO (BS; BHRS; CC)
Entity type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:
Last Name:ALFARO
Suffix:
Gender:M
Credentials:BS; BHRS; CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 S BAUCUM ST
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521-6607
Mailing Address - Country:US
Mailing Address - Phone:580-318-3730
Mailing Address - Fax:
Practice Address - Street 1:1313 N FORREST ST
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-2734
Practice Address - Country:US
Practice Address - Phone:580-318-3730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-01
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator