Healthcare Provider Details

I. General information

NPI: 1598254898
Provider Name (Legal Business Name): ELIZABETH BELEN DEYO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2018
Last Update Date: 10/28/2022
Certification Date: 10/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 15TH AVE E
SEATTLE WA
98112-5103
US

IV. Provider business mailing address

8720 14TH AVE S
SEATTLE WA
98108-4807
US

V. Phone/Fax

Practice location:
  • Phone: 206-326-3000
  • Fax: 877-515-2975
Mailing address:
  • Phone: 206-762-3730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number61200053
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: