Provider Demographics
NPI:1477820959
Name:MOTO, DORCAS MARIA (CHP)
Entity Type:Individual
Prefix:
First Name:DORCAS
Middle Name:MARIA
Last Name:MOTO
Suffix:
Gender:F
Credentials:CHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 MAIN STREET
Mailing Address - Street 2:BOX 23
Mailing Address - City:DEERING
Mailing Address - State:AK
Mailing Address - Zip Code:99736
Mailing Address - Country:US
Mailing Address - Phone:907-363-2137
Mailing Address - Fax:907-363-2177
Practice Address - Street 1:23 MAIN STREET
Practice Address - Street 2:
Practice Address - City:DEERING
Practice Address - State:AK
Practice Address - Zip Code:99736
Practice Address - Country:US
Practice Address - Phone:907-363-2137
Practice Address - Fax:907-363-2177
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK11-1133-II172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker