Provider Demographics
NPI:1174381834
Name:FUIAVA, TERANCE
Entity type:Individual
Prefix:
First Name:TERANCE
Middle Name:
Last Name:FUIAVA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 SPENARD RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99517-2903
Mailing Address - Country:US
Mailing Address - Phone:190-744-0400
Mailing Address - Fax:
Practice Address - Street 1:4110 SPENARD RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99517-2903
Practice Address - Country:US
Practice Address - Phone:190-744-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker