Healthcare Provider Details

I. General information

NPI: 1073332425
Provider Name (Legal Business Name): MIRIAM ALEJANDRA OLIVO M.E.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 10/08/2026
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 E 74TH AVE
ANCHORAGE AK
99507
US

IV. Provider business mailing address

1550 E 74TH AVE
ANCHORAGE AK
99507
US

V. Phone/Fax

Practice location:
  • Phone: 907-929-5826
  • Fax: 907-929-5862
Mailing address:
  • Phone: 907-929-5826
  • Fax: 907-929-5862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: