Healthcare Provider Details

I. General information

NPI: 1093649634
Provider Name (Legal Business Name): GRAZIELA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

753 HILLTOP AVE
KENT WA
98031-3117
US

IV. Provider business mailing address

753 HILLTOP AVE
KENT WA
98031-3117
US

V. Phone/Fax

Practice location:
  • Phone: 206-992-9700
  • Fax:
Mailing address:
  • Phone: 206-992-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number759090
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: