Healthcare Provider Details

I. General information

NPI: 1952068082
Provider Name (Legal Business Name): ALLIZON ZAZARY URRUTIA BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 SAN JERONIMO DR
ANCHORAGE AK
99508-2870
US

IV. Provider business mailing address

3600 SAN JERONIMO DR
ANCHORAGE AK
99508-2870
US

V. Phone/Fax

Practice location:
  • Phone: 908-793-3200
  • Fax:
Mailing address:
  • Phone: 908-793-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1982
Identifier TypeOTHER
Identifier StateAK
Identifier Issuer1979
# 2
Identifier1982
Identifier TypeOTHER
Identifier StateAK
Identifier Issuer1982

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: