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General NPI Number Information
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NPI Number | 1528401593
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Entity Type | Individual
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Provider Name | SISAY S JORGA LMP
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Gender | Female
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Dates
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Enumeration Date | 04/09/2013
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Last Update Date | 04/09/2013
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Provider Practice Location Address
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Address Line | 16418 7TH PL W STE B
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City | LYNNWOOD
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State | WA
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Zip | 98037-8100
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Country | US
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Telephone | 425-741-3030
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Fax |
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Provider Business Mailing Address
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Address Line | 12048 32ND AVE NE APT 304
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City | SEATTLE
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State | WA
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Zip | 98125-5543
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Country | US
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Telephone | 206-407-4914
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MA 60324977
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License Number State | WA
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