Momodoubolong Faitala, is a
Behavior Technician based in Anchorage, Alaska. Momodoubolong Faitala is licensed to practice in Alaska (license number RBT-21-196652) and his current practice location is
3105 Lakeshore Dr Ste A101, Anchorage, Alaska. He can be reached at his office (for appointments etc.) via phone at
(907) 302-9164.
NPI number for Momodoubolong Faitala is 1144810763 and his current mailing address is Po Box 241224, Anchorage, Alaska. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1144810763.
Healthcare Provider's Profile
| Full Name | Momodoubolong Faitala |
|---|
| Gender | Male |
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| Speciality | Behavior Technician |
|---|
| Location | 3105 Lakeshore Dr Ste A101, Anchorage, Alaska |
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1144810763
- Provider Enumeration Date: 01/19/2021
- Last Update Date: 12/17/2021
Medical Identifiers
Medical identifiers for Momodoubolong Faitala such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1144810763 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 106S00000X | Behavior Technician | RBT-21-196652 (Alaska) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Momodoubolong Faitala is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Momodoubolong Faitala,
Po Box 241224,
Anchorage, AK 99524-1224
Ph: (907) 302-9164 | Momodoubolong Faitala,
3105 Lakeshore Dr Ste A101,
Anchorage, AK 99517-2815
Ph: (907) 302-9164 |
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