Provider Demographics
NPI:1013440635
Name:PORTE, ROBIN CRISTOPHER
Entity Type:Individual
Prefix:
First Name:ROBIN CRISTOPHER
Middle Name:
Last Name:PORTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7924 RESURRECTION DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-4729
Mailing Address - Country:US
Mailing Address - Phone:907-952-1079
Mailing Address - Fax:907-337-5296
Practice Address - Street 1:7924 RESURRECTION DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-4729
Practice Address - Country:US
Practice Address - Phone:907-952-1079
Practice Address - Fax:907-337-5296
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101171310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility