Provider Demographics
NPI:1194858332
Name:RIVERA, ERLINDA ESTACIO
Entity Type:Individual
Prefix:MS
First Name:ERLINDA
Middle Name:ESTACIO
Last Name:RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7330 WINCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-2856
Mailing Address - Country:US
Mailing Address - Phone:907-334-3392
Mailing Address - Fax:907-334-3392
Practice Address - Street 1:7330 WINCHESTER ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-2856
Practice Address - Country:US
Practice Address - Phone:907-334-3392
Practice Address - Fax:907-334-3392
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK#8042376G00000X
AK100399385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKRL3392Medicaid