MEDICARE: ELIZABETH LADRIDO SANTIAGO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	000231	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RL0807	OTHER	AK	MCI

General Provider Information

NPI Number	:	1194948349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH LADRIDO SANTIAGO

Provider Business Mailing Address
First Line	:	8381 PIONEER DR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99504-4742
Country	:	US
Telephone Number	:	907-677-7466
Fax Number	:	907-334-9551

Provider Business Practice Location Address
First Line	:	8381 PIONEER DR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99504-4742
Country	:	US
Telephone Number	:	907-677-7466
Fax Number	:	907-334-9551

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	07/08/2007

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Directions to “ ELIZABETH LADRIDO SANTIAGO ” Practice Location

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