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Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. RONALD CORRAL (ADMINISTRATOR)
(907) 903-9552
Entity
Organization

Contact information

Practice address
9180 APHRODITE DR, ANCHORAGE, AK 99515-1499
(907) 903-8552
(907) 248-5276
Mailing address
9180 APHRODITE DR, ANCHORAGE, AK 99515-1499
(907) 248-5276
(907) 245-2782

Taxonomy

Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
100943
AK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
RLX
AK
Enumeration date
01/27/2015
Last updated
01/27/2015
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