Healthcare Provider Details

I. General information

NPI: 1033170402
Provider Name (Legal Business Name): NURIA PEREZ-REYES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 BROADWAY
SEATTLE WA
98122-4307
US

IV. Provider business mailing address

PO BOX 3941
SEATTLE WA
98124-3941
US

V. Phone/Fax

Practice location:
  • Phone: 206-386-6000
  • Fax:
Mailing address:
  • Phone: 206-386-2676
  • Fax: 206-386-2709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberMD0026601
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberMD00026601
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number4301066884
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: