Provider Demographics
NPI:1356771851
Name:MORA DEPAULA, ALTAGRACIA
Entity type:Individual
Prefix:
First Name:ALTAGRACIA
Middle Name:
Last Name:MORA DEPAULA
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 1:735 E 9TH AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-6204
Mailing Address - Country:US
Mailing Address - Phone:907-744-0597
Mailing Address - Fax:907-929-5858
Practice Address - Street 1:1399 W 34TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3659
Practice Address - Country:US
Practice Address - Phone:907-929-2828
Practice Address - Fax:907-929-5858
Is Sole Proprietor?:No
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK10048863747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant