Provider Demographics
NPI:1558155333
Name:ALFONZO, AIDA GABRIELLE (CPM, LM)
Entity type:Individual
Prefix:MS
First Name:AIDA
Middle Name:GABRIELLE
Last Name:ALFONZO
Suffix:
Gender:
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 W WILLIAM CANNON DR STE 503
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-5286
Mailing Address - Country:US
Mailing Address - Phone:512-243-8066
Mailing Address - Fax:
Practice Address - Street 1:2500 W WILLIAM CANNON DR STE 503
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-5286
Practice Address - Country:US
Practice Address - Phone:512-243-8066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife