Healthcare Provider Details

I. General information

NPI: 1164909206
Provider Name (Legal Business Name): SONIA LI JUAREZ ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2018
Last Update Date: 09/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2811 TIETON DR
YAKIMA WA
98902
US

IV. Provider business mailing address

4013 MCLEAN PL
YAKIMA WA
98908-3948
US

V. Phone/Fax

Practice location:
  • Phone: 509-575-8000
  • Fax:
Mailing address:
  • Phone: 509-969-2844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60898404
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN60282711
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: