Healthcare Provider Details

I. General information

NPI: 1508593757
Provider Name (Legal Business Name): RAFAELA SOFIA DOMINGO CASAYURAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 BROADWAY STE 301
TACOMA WA
98402-4454
US

IV. Provider business mailing address

950 BROADWAY STE 301
TACOMA WA
98402-4454
US

V. Phone/Fax

Practice location:
  • Phone: 253-671-9909
  • Fax:
Mailing address:
  • Phone: 253-671-9909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberLABA.AB.70107174
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: