MEDICARE: SELENA KRISTINA DIRICCO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		WA

General Provider Information

NPI Number	:	1023605649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SELENA KRISTINA DIRICCO

Provider Business Mailing Address
First Line	:	3909 N WALL ST APT 303
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99205-1191
Country	:	US
Telephone Number	:	509-994-1695
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 S FREYA ST STE 320
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99202-4867
Country	:	US
Telephone Number	:	509-761-9961
Fax Number	:	509-497-5004

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2020
Last Update Date	:	01/28/2026

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Directions to “ SELENA KRISTINA DIRICCO ” Practice Location

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