Healthcare Provider Details

I. General information

NPI: 1326239682
Provider Name (Legal Business Name): MICHAEL JESS AQUIRRE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

3333 N WHITMAN ST
TACOMA WA
98407-1547
US

IV. Provider business mailing address

3333 N WHITMAN ST
TACOMA WA
98407-1547
US

V. Phone/Fax

Practice location:
  • Phone: 253-759-3065
  • Fax: 253-759-3075
Mailing address:
  • Phone: 253-759-3065
  • Fax: 253-759-3075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License NumberST00003623
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: