Healthcare Provider Details

I. General information

NPI: 1902478886
Provider Name (Legal Business Name): DANIELA ELISA FERMIN GONCALVES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 07/12/2021
Certification Date: 07/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3808 S ANGELINE ST
SEATTLE WA
98118-1712
US

IV. Provider business mailing address

520 TERRY AVE UNIT 712
SEATTLE WA
98104-2296
US

V. Phone/Fax

Practice location:
  • Phone: 206-461-4880
  • Fax:
Mailing address:
  • Phone: 781-301-1359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: