Healthcare Provider Details

I. General information

NPI: 1629118427
Provider Name (Legal Business Name): LOREN J RICCIO ND,LM,CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15650 NE 24TH ST STE A
BELLEVUE WA
98008-2460
US

IV. Provider business mailing address

15650 NE 24TH ST STE A
BELLEVUE WA
98008-2460
US

V. Phone/Fax

Practice location:
  • Phone: 425-202-5203
  • Fax: 800-641-1831
Mailing address:
  • Phone: 425-505-2745
  • Fax: 425-505-2579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW293
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT1311
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: