1144900713 NPI number — SHARON CARRASQUILLO TORRES AAS, CDC CT

Table of content: SHARON CARRASQUILLO TORRES AAS, CDC CT (NPI 1144900713)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144900713 NPI number — SHARON CARRASQUILLO TORRES AAS, CDC CT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARRASQUILLO TORRES
Provider First Name:
SHARON
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AAS, CDC CT
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:
1144900713
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1027 EVERGREEN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRBANKS
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99709-4306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:
907-456-4849

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1027 EVERGREEN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRBANKS
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99709-4306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-451-8164
Provider Business Practice Location Address Fax Number:
907-456-4849
Provider Enumeration Date:
07/19/2023

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: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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