Healthcare Provider Details

I. General information

NPI: 1538949524
Provider Name (Legal Business Name): JOCELYN SABRINA VIVAS CASTILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2023
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST SEATTLE
SEATTLE WA
98195-0001
US

IV. Provider business mailing address

1401 168TH AVE NE
BELLEVUE WA
98008-3033
US

V. Phone/Fax

Practice location:
  • Phone: 206-685-2937
  • Fax:
Mailing address:
  • Phone: 206-619-1803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License NumberDE61353805
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE61353805
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: