Healthcare Provider Details

I. General information

NPI: 1104023894
Provider Name (Legal Business Name): MONINA DAGUIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9635 17TH AVE SW
SEATTLE WA
98106-2712
US

IV. Provider business mailing address

9635 17TH AVE SW
SEATTLE WA
98106-2712
US

V. Phone/Fax

Practice location:
  • Phone: 206-763-5057
  • Fax: 206-763-5241
Mailing address:
  • Phone: 206-763-5057
  • Fax: 206-763-5241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0116017100
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: