Provider Demographics
NPI:1275114209
Name:COLEGADO, CLARISSA JORE
Entity Type:Individual
Prefix:
First Name:CLARISSA
Middle Name:JORE
Last Name:COLEGADO
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 1:3609 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-1134
Mailing Address - Country:US
Mailing Address - Phone:907-743-2996
Mailing Address - Fax:907-742-2991
Practice Address - Street 1:3609 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-1134
Practice Address - Country:US
Practice Address - Phone:907-743-2996
Practice Address - Fax:907-743-2991
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider