Healthcare Provider Details

I. General information

NPI: 1407906472
Provider Name (Legal Business Name): GABRIELA ESTRADA VELAZQUEZ LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 09/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14439 AMBAUM BLVD SW
BURIEN WA
98166-1423
US

IV. Provider business mailing address

8600 25TH AVE SW #B317
SEATTLE WA
98106-3296
US

V. Phone/Fax

Practice location:
  • Phone: 206-607-7154
  • Fax: 253-852-3102
Mailing address:
  • Phone: 206-607-7154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175L00000X
TaxonomyHomeopath
License NumberMA00016898
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: