Healthcare Provider Details

I. General information

NPI: 1851691174
Provider Name (Legal Business Name): CATHELIYA B SUWANAKRIT 06/22/2010 NAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2010
Last Update Date: 02/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3156 SPORTS ARENA BLVD SUITE 106
SAN DIEGO CA
92110
US

IV. Provider business mailing address

22400 87TH AVE W
EDMONDS WA
98026-8224
US

V. Phone/Fax

Practice location:
  • Phone: 619-569-3260
  • Fax:
Mailing address:
  • Phone: 206-491-1337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number5792
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberNA 60157699
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberNA 60157699
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: