Healthcare Provider Details

I. General information

NPI: 1083180483
Provider Name (Legal Business Name): MARIA EUGENIA GUZMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2018
Last Update Date: 10/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10344 14TH AVE S
SEATTLE WA
98168-1689
US

IV. Provider business mailing address

1202 N 10TH PL APT 1326
RENTON WA
98057-5641
US

V. Phone/Fax

Practice location:
  • Phone: 206-788-3200
  • Fax:
Mailing address:
  • Phone: 206-941-2858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLP60574981
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: