Provider Demographics
NPI:1306971650
Name:MARCONTELL, AIDE' RODRIGUEZ (HS1)
Entity type:Individual
Prefix:
First Name:AIDE'
Middle Name:RODRIGUEZ
Last Name:MARCONTELL
Suffix:
Gender:F
Credentials:HS1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1980 ANCHORAGE PORT RD
Mailing Address - Street 2:MSST ANCHORAGE (91111)
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-1022
Mailing Address - Country:US
Mailing Address - Phone:907-271-8119
Mailing Address - Fax:907-271-8140
Practice Address - Street 1:1980 ANCHORAGE PORT RD
Practice Address - Street 2:MSST ANCHORAGE (91111)
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-1022
Practice Address - Country:US
Practice Address - Phone:907-271-8119
Practice Address - Fax:907-271-8140
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman