Healthcare Provider Details

I. General information

NPI: 1265579874
Provider Name (Legal Business Name): RACHEL DAIGH WILSON RODRIGUEZ L.AC., LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8310 165TH AVE NE
REDMOND WA
98052-3907
US

IV. Provider business mailing address

13643 92ND PL NE
KIRKLAND WA
98034-1845
US

V. Phone/Fax

Practice location:
  • Phone: 425-891-6719
  • Fax:
Mailing address:
  • Phone: 425-891-6719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00002429
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: