Healthcare Provider Details

I. General information

NPI: 1477812873
Provider Name (Legal Business Name): ALFONSO RICARDO URDANETA-MONCADA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2012
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19020 33RD AVE W STE 210
LYNNWOOD WA
98036-4748
US

IV. Provider business mailing address

19020 33RD AVE W STE 210
LYNNWOOD WA
98036-4748
US

V. Phone/Fax

Practice location:
  • Phone: 425-563-1500
  • Fax: 425-563-1501
Mailing address:
  • Phone: 425-563-1500
  • Fax: 425-563-1501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number116005
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberMD60665935
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberM-13632
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number116005
License Number StateAK
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberM-13632
License Number StateID
# 6
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301501630
License Number StateMI
# 7
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD60665935
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: