Healthcare Provider Details

I. General information

NPI: 1700079738
Provider Name (Legal Business Name): MR. ANGEL TUTAAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 09/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10057 MARMOT CIR
ANCHORAGE AK
99515-2346
US

IV. Provider business mailing address

10057 MARMOT CIR
ANCHORAGE AK
99515-2346
US

V. Phone/Fax

Practice location:
  • Phone: 907-349-9137
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: