Healthcare Provider Details

I. General information

NPI: 1518312453
Provider Name (Legal Business Name): CARLA MICHELLE CARTAGENA DE JESUS M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARLA MICHELLE CARTAGENA M.D

II. Dates (important events)

Enumeration Date: 04/28/2016
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 NOBLE ST STE 1
FAIRBANKS AK
99701-4991
US

IV. Provider business mailing address

PO BOX 73720
FAIRBANKS AK
99707-3720
US

V. Phone/Fax

Practice location:
  • Phone: 907-459-3500
  • Fax:
Mailing address:
  • Phone: 907-459-3500
  • Fax: 907-459-3526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR75496
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number143269
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: