Healthcare Provider Details

I. General information

NPI: 1891764353
Provider Name (Legal Business Name): MARIA TERESA DE LA MORENA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE M/S: HB.B.501
SEATTLE WA
98105
US

IV. Provider business mailing address

4800 SAND POINT WAY NE M/S: HB.B.501
SEATTLE WA
98105
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-7450
  • Fax: 206-985-3119
Mailing address:
  • Phone: 206-987-7450
  • Fax: 206-985-3119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License NumberM2598
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: