Healthcare Provider Details

I. General information

NPI: 1952136905
Provider Name (Legal Business Name): ANNA MARGARITA GOROSPE CUDIAMAT BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2024
Last Update Date: 09/07/2024
Certification Date: 09/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30218 21ST AVE S
FEDERAL WAY WA
98003-4249
US

IV. Provider business mailing address

30218 21ST AVE S
FEDERAL WAY WA
98003-4249
US

V. Phone/Fax

Practice location:
  • Phone: 253-256-9405
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60203729
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: