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NPI Code Detail

MEDICARE: MARIA VERONICA VALLEJOS CASTILLO DDS

MEDICARE: MARIA VERONICA VALLEJOS CASTILLO DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training ProgramZZ
21223G0001XGeneral Practice Dentistry61145500WA

General Provider Information

NPI Number : 1104203942
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIA VERONICA VALLEJOS CASTILLO DDS
Provider Business Mailing Address
First Line : 6316 26TH AVE NW
Second Line :
City : SEATTLE
State : WA
Zip : 98107-2427
Country : US
Telephone Number : 786-510-5254
Fax Number :
Provider Business Practice Location Address
First Line : 2911 2ND AVE STE 106
Second Line :
City : SEATTLE
State : WA
Zip : 98121-5120
Country : US
Telephone Number : 786-510-5254
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/30/2015
Last Update Date : 09/20/2021

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Directions to “ MARIA VERONICA VALLEJOS CASTILLO DDS” Practice Location

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