Healthcare Provider Details

I. General information

NPI: 1558971010
Provider Name (Legal Business Name): RAQUEL GM INCHAUSTE LANGUAGE PROVIDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2020
Last Update Date: 09/15/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10450 SE 13TH ST
BELLEVUE WA
98004-6850
US

IV. Provider business mailing address

10450 SE 13TH ST
BELLEVUE WA
98004-6850
US

V. Phone/Fax

Practice location:
  • Phone: 425-785-5760
  • Fax:
Mailing address:
  • Phone: 425-785-5760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License NumberMC7958
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: