Provider Demographics
NPI:1063070076
Name:DEL ROSARIO, MA KRISTEL ORTILLA
Entity type:Individual
Prefix:
First Name:MA KRISTEL
Middle Name:ORTILLA
Last Name:DEL ROSARIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MA KRISTEL
Other - Middle Name:CARAAN
Other - Last Name:ORTILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:BARROW
Mailing Address - State:AK
Mailing Address - Zip Code:99723-0069
Mailing Address - Country:US
Mailing Address - Phone:907-852-0366
Mailing Address - Fax:907-852-0268
Practice Address - Street 1:5200 KARLUK ST.
Practice Address - Street 2:
Practice Address - City:BARROW
Practice Address - State:AK
Practice Address - Zip Code:99723-0069
Practice Address - Country:US
Practice Address - Phone:907-852-0366
Practice Address - Fax:907-852-0268
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)