Healthcare Provider Details

I. General information

NPI: 1750612123
Provider Name (Legal Business Name): CRISTINA DUVALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2010
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4526 FEDERAL AVE
EVERETT WA
98203-2132
US

IV. Provider business mailing address

4526 FEDERAL AVE
EVERETT WA
98203-2132
US

V. Phone/Fax

Practice location:
  • Phone: 425-349-6200
  • Fax:
Mailing address:
  • Phone: 425-349-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP61042964
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00069477
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: