Healthcare Provider Details

I. General information

NPI: 1588398374
Provider Name (Legal Business Name): JANETH CRUZ GAYTAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2022
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4111 ALDERWOOD MALL BLVD
LYNNWOOD WA
98036-6765
US

IV. Provider business mailing address

17410 52ND AVE W UNIT 11
LYNNWOOD WA
98037-3051
US

V. Phone/Fax

Practice location:
  • Phone: 425-616-4100
  • Fax:
Mailing address:
  • Phone: 425-480-4151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number61300480
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: