Healthcare Provider Details

I. General information

NPI: 1225281991
Provider Name (Legal Business Name): KENDRA EGUIA CHA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SLOCUM DRIVE
KING COVE AK
99612
US

IV. Provider business mailing address

3380 C ST SUITE 100
ANCHORAGE AK
99503-3949
US

V. Phone/Fax

Practice location:
  • Phone: 907-497-2311
  • Fax: 907-497-2310
Mailing address:
  • Phone: 907-277-1440
  • Fax: 907-277-1446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number261QC1500X
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: