MEDICARE: DR. LOREN J RICCIO ND,LM,CPM

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
1	176B00000X	Midwife	MW293	WA
2	175F00000X	Naturopath	NT1311	WA

General Provider Information

NPI Number	:	1629118427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOREN J RICCIO ND,LM,CPM

Provider Business Mailing Address
First Line	:	15650 NE 24TH ST
Second Line	:	STE A
City	:	BELLEVUE
State	:	WA
Zip	:	98008-2460
Country	:	US
Telephone Number	:	425-505-2745
Fax Number	:	425-505-2579

Provider Business Practice Location Address
First Line	:	15650 NE 24TH ST
Second Line	:	STE A
City	:	BELLEVUE
State	:	WA
Zip	:	98008-2460
Country	:	US
Telephone Number	:	425-202-5203
Fax Number	:	800-641-1831

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	07/20/2020

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