Healthcare Provider Details

I. General information

NPI: 1447023403
Provider Name (Legal Business Name): ALVARO A VASQUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2023
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 S CUSHMAN AVE
TACOMA WA
98405-3631
US

IV. Provider business mailing address

PO BOX 34703
SEATTLE WA
98124-1703
US

V. Phone/Fax

Practice location:
  • Phone: 253-534-2144
  • Fax:
Mailing address:
  • Phone: 206-784-0502
  • Fax: 208-764-0516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberWDL6RTR8F2SB
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: