Healthcare Provider Details

I. General information

NPI: 1952601916
Provider Name (Legal Business Name): ANN MILLIRON ESPINOSA L.M.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2010
Last Update Date: 08/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3216 NE 45TH PLACE #117
SEATTLE WA
98105
US

IV. Provider business mailing address

3216 NE 45TH PALCE #117
SEATTLE WA
98105
US

V. Phone/Fax

Practice location:
  • Phone: 425-954-7404
  • Fax: 206-641-7596
Mailing address:
  • Phone: 425-954-7404
  • Fax: 206-641-7596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60184192
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberBA MA 60184192
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: