Provider Demographics
NPI:1902158363
Name:CAGUIOA, MARY GRACE ALAS
Entity Type:Individual
Prefix:
First Name:MARY GRACE
Middle Name:ALAS
Last Name:CAGUIOA
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 1:5041 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1429
Mailing Address - Country:US
Mailing Address - Phone:907-351-2683
Mailing Address - Fax:
Practice Address - Street 1:5041 LAUREL ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-1429
Practice Address - Country:US
Practice Address - Phone:907-351-2683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator