Healthcare Provider Details

I. General information

NPI: 1770066557
Provider Name (Legal Business Name): MARIO ERNESTO PAREDES-JOVEL CG60323792
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2018
Last Update Date: 09/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3808 S ANGELINE ST
SEATTLE WA
98118-1712
US

IV. Provider business mailing address

3808 S ANGELINE ST
SEATTLE WA
98118-1712
US

V. Phone/Fax

Practice location:
  • Phone: 206-461-4880
  • Fax: 206-461-6989
Mailing address:
  • Phone: 206-461-4880
  • Fax: 206-461-6989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCG60323792
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: