Healthcare Provider Details

I. General information

NPI: 1104554229
Provider Name (Legal Business Name): GIOVANNI PAOLO ARQUILETA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2022
Last Update Date: 08/09/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8862 161ST AVE NE STE 102
REDMOND WA
98052-7553
US

IV. Provider business mailing address

13831 NE 8TH ST
BELLEVUE WA
98005-3484
US

V. Phone/Fax

Practice location:
  • Phone: 425-883-9532
  • Fax: 425-882-2743
Mailing address:
  • Phone: 425-518-5721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA61109212
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: