Healthcare Provider Details

I. General information

NPI: 1568243947
Provider Name (Legal Business Name): QUENNIE YHEN ESLAVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2023
Last Update Date: 10/22/2024
Certification Date: 10/11/2023
Deactivation Date: 01/17/2024
Reactivation Date: 10/22/2024

III. Provider practice location address

19401 40TH AVE W STE 100
LYNNWOOD WA
98036-5600
US

IV. Provider business mailing address

24000 VAN RY BLVD APT 647
MOUNTLAKE TERRACE WA
98043-5485
US

V. Phone/Fax

Practice location:
  • Phone: 253-426-9856
  • Fax:
Mailing address:
  • Phone: 253-426-9856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: