Healthcare Provider Details

I. General information

NPI: 1063014165
Provider Name (Legal Business Name): MASSIEL ALEXANDRA SANTOS DIAZ ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2020
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 8TH AVE S
SEATTLE WA
98104-3032
US

IV. Provider business mailing address

PO BOX 3007
SEATTLE WA
98114-3007
US

V. Phone/Fax

Practice location:
  • Phone: 206-788-3700
  • Fax: 206-962-3298
Mailing address:
  • Phone: 206-788-3700
  • Fax: 206-962-3298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11010165
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61173621
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: