Provider Demographics
NPI:1851553044
Name:CALETENA, DEMETRIA C
Entity Type:Individual
Prefix:
First Name:DEMETRIA
Middle Name:C
Last Name:CALETENA
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 1:2812 W 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99517-1701
Mailing Address - Country:US
Mailing Address - Phone:907-868-1795
Mailing Address - Fax:907-868-1795
Practice Address - Street 1:310 ELLEN CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-3388
Practice Address - Country:US
Practice Address - Phone:907-868-1795
Practice Address - Fax:907-868-1795
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100527320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities