Healthcare Provider Details

I. General information

NPI: 1457230179
Provider Name (Legal Business Name): PERLA ITZELL ESPEJO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PERLA ITZELL KELBON

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9914 18TH AVE W UNIT C
EVERETT WA
98204-1469
US

IV. Provider business mailing address

9914 18TH AVE W UNIT C
EVERETT WA
98204-1469
US

V. Phone/Fax

Practice location:
  • Phone: 425-268-7915
  • Fax:
Mailing address:
  • Phone: 425-268-7915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN61109998
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: