1255589453 NPI number — MRS. OFELIA ISENIA GUIEL CUA

Table of content: MRS. OFELIA ISENIA GUIEL CUA (NPI 1255589453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255589453 NPI number — MRS. OFELIA ISENIA GUIEL CUA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUIEL
Provider First Name:
OFELIA
Provider Middle Name:
ISENIA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CUA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255589453
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 211029
Provider Second Line Business Mailing Address:
CHRISTIAN COTTAGE ASSISTED LIVING
Provider Business Mailing Address City Name:
ANCHORAGE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-333-0556
Provider Business Mailing Address Fax Number:
907-339-0430

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8301 E 11TH COURT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-333-0556
Provider Business Practice Location Address Fax Number:
907-339-0430
Provider Enumeration Date:
09/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 376K00000X , with the licence number:  3992 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: RL23732 . This is a "CHOICE WAIVER FIRST HEALTH" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com