Healthcare Provider Details

I. General information

NPI: 1235960576
Provider Name (Legal Business Name): DAENA PUENTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 08/09/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5909 ORCHARD ST W
TACOMA WA
98467-3824
US

IV. Provider business mailing address

1104 200TH STREET CT E
SPANAWAY WA
98387-8164
US

V. Phone/Fax

Practice location:
  • Phone: 253-474-6021
  • Fax:
Mailing address:
  • Phone: 253-230-2712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: