Provider Demographics
NPI:1689653339
Name:ANDERSON, CHUCK (HS)
Entity Type:Individual
Prefix:MR
First Name:CHUCK
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:HS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:B20 CALLE 5
Mailing Address - Street 2:SANTA ANNA AVE
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-6608
Mailing Address - Country:US
Mailing Address - Phone:787-729-2305
Mailing Address - Fax:
Practice Address - Street 1:COMMANDING OFFICER 5 CALLE LA PUNTILLA
Practice Address - Street 2:USCG SECTOR SAN JUAN
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00901
Practice Address - Country:US
Practice Address - Phone:787-729-2305
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other