Healthcare Provider Details

I. General information

NPI: 1265902001
Provider Name (Legal Business Name): EDITH ARMENDARIZ AAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2018
Last Update Date: 12/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 100TH ST SE STE A2
EVERETT WA
98208-3832
US

IV. Provider business mailing address

1920 100TH ST SE STE A2
EVERETT WA
98208-3832
US

V. Phone/Fax

Practice location:
  • Phone: 425-312-0277
  • Fax: 425-312-0280
Mailing address:
  • Phone: 425-312-0277
  • Fax: 425-312-0280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCG60885620
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: