MEDICARE: CRISALYN BUENARTE RUIZ

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	3104A0625X	Assisted Living Facility (Mental Illness)	101367	AK

General Provider Information

NPI Number	:	1841815321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISALYN BUENARTE RUIZ

Provider Business Mailing Address
First Line	:	2108 W 47TH AVE
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99517-3165
Country	:	US
Telephone Number	:	907-887-6052
Fax Number	:

Provider Business Practice Location Address
First Line	:	3541 CORONA CIR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99517-1486
Country	:	US
Telephone Number	:	907-887-6052
Fax Number	:

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

Provider Enumeration Date	:	06/10/2020
Last Update Date	:	06/10/2020

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