Healthcare Provider Details

I. General information

NPI: 1336331206
Provider Name (Legal Business Name): MRS. CARMEN ZORAIDA REINHARDT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 08/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13002 SE 188TH ST
RENTON WA
98058-7910
US

IV. Provider business mailing address

13002 SE 188TH ST
RENTON WA
98058-7910
US

V. Phone/Fax

Practice location:
  • Phone: 425-793-4052
  • Fax: 425-793-4052
Mailing address:
  • Phone: 425-793-4052
  • Fax: 425-793-4052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: