Healthcare Provider Details

I. General information

NPI: 1225805948
Provider Name (Legal Business Name): CHRISTIAN LILI VALLADARES MENDOZA SC61510017
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 N YOUNG ST STE E
KENNEWICK WA
99336-7662
US

IV. Provider business mailing address

1313 N YOUNG ST STE E
KENNEWICK WA
99336-7662
US

V. Phone/Fax

Practice location:
  • Phone: 509-378-0214
  • Fax:
Mailing address:
  • Phone: 509-378-0214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSC61510017
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: