Healthcare Provider Details

I. General information

NPI: 1295937290
Provider Name (Legal Business Name): VINA VILLOSO APELLANES LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15027 AURORA AVE N
SHORELINE WA
98133-6134
US

IV. Provider business mailing address

15325 STONE AVE N
SHORELINE WA
98133-6221
US

V. Phone/Fax

Practice location:
  • Phone: 206-362-3520
  • Fax:
Mailing address:
  • Phone: 206-383-7725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA00023282
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: