Healthcare Provider Details

I. General information

NPI: 1477041275
Provider Name (Legal Business Name): KAYLA GRIGGS R.T. (R)
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 04/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3925 159TH AVE NE
REDMOND WA
98052-6309
US

IV. Provider business mailing address

3925 159TH AVE NE
REDMOND WA
98052-6309
US

V. Phone/Fax

Practice location:
  • Phone: 949-891-0328
  • Fax:
Mailing address:
  • Phone: 949-891-0328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number60655946
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: