Healthcare Provider Details

I. General information

NPI: 1487070728
Provider Name (Legal Business Name): MILKO FERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2014
Last Update Date: 03/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14090 FRYELANDS BLVD SE STE 347
MONROE WA
98272-2760
US

IV. Provider business mailing address

1315 PACIFIC AVE APT 322
EVERETT WA
98201-4289
US

V. Phone/Fax

Practice location:
  • Phone: 360-805-3122
  • Fax: 360-805-9180
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: