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NPI Code Detail

MEDICARE: CORDERO ALLAN WADE-GONZALES

MEDICARE: CORDERO ALLAN WADE-GONZALES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
2171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1821643412
Entity Type Code : Individual
Provider Name (Legal Business Name) : CORDERO ALLAN WADE-GONZALES
Provider Business Mailing Address
First Line : 2405 GLENKERRY DR
Second Line :
City : ANCHORAGE
State : AK
Zip : 99504-3236
Country : US
Telephone Number : 907-306-8693
Fax Number : 907-333-4383
Provider Business Practice Location Address
First Line : 3710 E 20TH AVE
Second Line :
City : ANCHORAGE
State : AK
Zip : 99508-3418
Country : US
Telephone Number : 907-306-8693
Fax Number : 907-257-1091
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2019
Last Update Date : 04/25/2022

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Directions to “ CORDERO ALLAN WADE-GONZALES ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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