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General NPI Number Information
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NPI Number | 1871636514
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Entity Type | Organization
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Legal Business Name | ALASKA FETAL IMAGING, LLC
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4050 LK. OTIS PKWY STE 100-A
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City | ANKORAGE
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State | AK
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Zip | 99508
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Country | US
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Telephone | 907-770-6464
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Fax | 907-770-6464
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Provider Business Mailing Address
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Address Line | 4050 LK. OTIS PKWY STE 100-A
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City | ANKORAGE
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State | AK
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Zip | 99508
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Country | US
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Telephone | 907-770-6464
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Fax | 907-770-6464
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Authorized Official
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Title or Position | BUS. MNGS.
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Name | DELORES L. BAKER
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Credential | BA
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Telephone | 907-770-6464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number | 3385
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License Number State | AK
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