Healthcare Provider Details

I. General information

NPI: 1194858332
Provider Name (Legal Business Name): MS. ERLINDA ESTACIO RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7330 WINCHESTER ST
ANCHORAGE AK
99507-2856
US

IV. Provider business mailing address

7330 WINCHESTER ST
ANCHORAGE AK
99507-2856
US

V. Phone/Fax

Practice location:
  • Phone: 907-334-3392
  • Fax: 907-334-3392
Mailing address:
  • Phone: 907-334-3392
  • Fax: 907-334-3392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number#8042
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number100399
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: