Provider Demographics
NPI:1265760938
Name:BULTRON, RAFAEL (CDC1)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:BULTRON
Suffix:
Gender:M
Credentials:CDC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 C ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3913
Mailing Address - Country:US
Mailing Address - Phone:907-273-4080
Mailing Address - Fax:907-273-4005
Practice Address - Street 1:3001 C ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3913
Practice Address - Country:US
Practice Address - Phone:907-273-4080
Practice Address - Fax:907-273-4005
Is Sole Proprietor?:No
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)