Healthcare Provider Details

I. General information

NPI: 1225505985
Provider Name (Legal Business Name): ELENITA DAGDAG PARAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2018
Last Update Date: 11/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10344 14TH AVE S
SEATTLE WA
98168-1689
US

IV. Provider business mailing address

28387 33RD LN S
AUBURN WA
98001-1831
US

V. Phone/Fax

Practice location:
  • Phone: 206-245-1086
  • Fax:
Mailing address:
  • Phone: 206-250-5034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberCM60365736
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: