Healthcare Provider Details

I. General information

NPI: 1578910501
Provider Name (Legal Business Name): EMMANUEL JAUREGUI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2016
Last Update Date: 08/08/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST CAMPUS BOX 356515
SEATTLE WA
98195-0001
US

IV. Provider business mailing address

1959 NE PACIFIC ST CAMPUS BOX 356515
SEATTLE WA
98195
US

V. Phone/Fax

Practice location:
  • Phone: 206-598-4022
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License NumberDR.0068488
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: