Healthcare Provider Details

I. General information

NPI: 1922157296
Provider Name (Legal Business Name): URSULA ERIKA MARQUEZ LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 01/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 130TH AVE NE SUITE B-103
BELLEVUE WA
98005-1799
US

IV. Provider business mailing address

1540 140TH AVE NE #100
BELLEVUE WA
98005-4516
US

V. Phone/Fax

Practice location:
  • Phone: 425-881-2310
  • Fax: 425-881-2312
Mailing address:
  • Phone: 425-644-6048
  • Fax: 425-641-2721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00000308
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: