Healthcare Provider Details

I. General information

NPI: 1457952145
Provider Name (Legal Business Name): LOURDES PRIETO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2020
Last Update Date: 11/08/2020
Certification Date: 11/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11522 157TH CT NE
REDMOND WA
98052-2453
US

IV. Provider business mailing address

11522 157TH CT NE
REDMOND WA
98052-2453
US

V. Phone/Fax

Practice location:
  • Phone: 509-728-1377
  • Fax:
Mailing address:
  • Phone: 509-728-1377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: