Healthcare Provider Details

I. General information

NPI: 1174340590
Provider Name (Legal Business Name): EMILY GRACE ESPINA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 09/25/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8725 S 212TH ST
KENT WA
98031-1921
US

IV. Provider business mailing address

1811 N 80TH ST # A
SEATTLE WA
98103-4501
US

V. Phone/Fax

Practice location:
  • Phone: 425-658-3016
  • Fax:
Mailing address:
  • Phone: 408-647-0606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: