Healthcare Provider Details

I. General information

NPI: 1639734775
Provider Name (Legal Business Name): GRICELDA LARIOS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2019
Last Update Date: 05/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

918 E MEAD AVE
YAKIMA WA
98903-3720
US

IV. Provider business mailing address

115 S 57TH ST
YAKIMA WA
98901-1603
US

V. Phone/Fax

Practice location:
  • Phone: 509-453-1344
  • Fax:
Mailing address:
  • Phone: 509-307-5520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60926353
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: