Provider Demographics
NPI:1992963904
Name:ALONZO, VERONICA (OTR)
Entity type:Individual
Prefix:MS
First Name:VERONICA
Middle Name:
Last Name:ALONZO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6422 S CAGE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-6957
Mailing Address - Country:US
Mailing Address - Phone:956-475-3681
Mailing Address - Fax:956-502-5485
Practice Address - Street 1:6422 S CAGE BLVD STE A
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-6957
Practice Address - Country:US
Practice Address - Phone:956-783-7111
Practice Address - Fax:956-783-7109
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110123225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX287630201Medicaid
TX309624001Medicaid