Healthcare Provider Details

I. General information

NPI: 1306442025
Provider Name (Legal Business Name): DINA EL SARTY LSWAIC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2020
Last Update Date: 03/21/2022
Certification Date: 03/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11700 MUKILTEO SPEEDWAY STE 201-4012
MUKILTEO WA
98275-5432
US

IV. Provider business mailing address

11700 MUKILTEO SPEEDWAY STE 201-4012
MUKILTEO WA
98275-5432
US

V. Phone/Fax

Practice location:
  • Phone: 360-203-6133
  • Fax:
Mailing address:
  • Phone: 360-203-6133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: