Healthcare Provider Details

I. General information

NPI: 1699324129
Provider Name (Legal Business Name): ANTHONY DELOSREYES DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2019
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 TALLMAN AVE NW
SEATTLE WA
98107-3932
US

IV. Provider business mailing address

21230 40TH WAY S UNIT C
SEATAC WA
98198-4241
US

V. Phone/Fax

Practice location:
  • Phone: 206-781-6209
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61006001
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: