Healthcare Provider Details

I. General information

NPI: 1396229241
Provider Name (Legal Business Name): ANDORA RAQUEL AZABACHE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2018
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 AUBURN WAY N
AUBURN WA
98002-1805
US

IV. Provider business mailing address

2508 33RD AVE SE
PUYALLUP WA
98374-4131
US

V. Phone/Fax

Practice location:
  • Phone: 253-999-5750
  • Fax: 253-999-5740
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61003702
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA61003702
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: