Healthcare Provider Details

I. General information

NPI: 1932564093
Provider Name (Legal Business Name): DARLA LLAMAS LP00057026
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2015
Last Update Date: 12/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 YAKIMA AVE
TACOMA WA
98405-4851
US

IV. Provider business mailing address

7303 199TH STREET CT E
SPANAWAY WA
98387-5646
US

V. Phone/Fax

Practice location:
  • Phone: 253-396-5246
  • Fax:
Mailing address:
  • Phone: 253-847-3787
  • Fax: 253-847-3787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLP 00057026
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: