Healthcare Provider Details

I. General information

NPI: 1578695037
Provider Name (Legal Business Name): MS. DIANA JANE ESPELINBERGO SOLANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2007
Last Update Date: 07/08/2007
Certification Date:
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

11211 NE 140TH ST
KIRKLAND WA
98034-5318
US

V. Phone/Fax

Practice location:
  • Phone: 425-883-9532
  • Fax:
Mailing address:
  • Phone: 425-442-0442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA00067498
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: