Provider Demographics
NPI:1871131318
Name:ALFARO, NICOLETA (MC)
Entity type:Individual
Prefix:
First Name:NICOLETA
Middle Name:
Last Name:ALFARO
Suffix:
Gender:F
Credentials:MC
Other - Prefix:
Other - First Name:NICOLETA
Other - Middle Name:
Other - Last Name:ALFARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:122 S COBBLESTONE DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-1350
Mailing Address - Country:US
Mailing Address - Phone:602-499-9187
Mailing Address - Fax:
Practice Address - Street 1:690 E WARNER RD STE 115
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-3056
Practice Address - Country:US
Practice Address - Phone:602-499-9187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health