Provider Demographics
NPI:1295167179
Name:ACHAS, BENITO ARTILLERO (CDC1)
Entity type:Individual
Prefix:MR
First Name:BENITO
Middle Name:ARTILLERO
Last Name:ACHAS
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 1:201 KASHEVAROFF AVE APT 206
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-6385
Mailing Address - Country:US
Mailing Address - Phone:907-486-3172
Mailing Address - Fax:
Practice Address - Street 1:717 E REZANOF DR
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-6416
Practice Address - Country:US
Practice Address - Phone:907-481-2400
Practice Address - Fax:907-481-2419
Is Sole Proprietor?:No
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2266101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMH2237Medicaid