Provider Demographics
NPI:1659851798
Name:RAFAEL, VIRGINIA MAYAO
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:MAYAO
Last Name:RAFAEL
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 1:1130 CONTRARY CT
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-2108
Mailing Address - Country:US
Mailing Address - Phone:907-339-9302
Mailing Address - Fax:907-339-9403
Practice Address - Street 1:1130 CONTRARY CT
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-2108
Practice Address - Country:US
Practice Address - Phone:907-339-9302
Practice Address - Fax:907-339-9403
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKNUAA13358374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide