Basic Information
| Provider Information | |||||||||
| NPI: | 1356771851 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MORA DEPAULA | ||||||||
| FirstName: | ALTAGRACIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 735 E 9TH AVE APT 4 | ||||||||
| Address2: | |||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995016204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077440597 | ||||||||
| FaxNumber: | 9079295858 | ||||||||
| Practice Location | |||||||||
| Address1: | 1399 W 34TH AVE STE 101 | ||||||||
| Address2: | |||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995033659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9079292828 | ||||||||
| FaxNumber: | 9079295858 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2013 | ||||||||
| LastUpdateDate: | 11/19/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3747P1801X | 1004886 | AK | Y | Nursing Service Related Providers | Technician | Personal Care Attendant |
No ID Information.