Provider Demographics
NPI:1447657002
Name:HAEDO-GONZALEZ, ALEXANDER P
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:P
Last Name:HAEDO-GONZALEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4590 ZION AVE APT 13
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-2537
Mailing Address - Country:US
Mailing Address - Phone:850-375-3984
Mailing Address - Fax:
Practice Address - Street 1:4590 ZION AVE APT 13
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-2537
Practice Address - Country:US
Practice Address - Phone:850-375-3984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman