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NPI Code Detail

MEDICARE: ANDORA RAQUEL AZABACHE PA-C

MEDICARE:   ANDORA RAQUEL AZABACHE  PA-C
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
1363AM0700XMedical Physician AssistantPA61003702WA
2363A00000XPhysician AssistantPA61003702WA

General Provider Information

NPI Number : 1396229241
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDORA RAQUEL AZABACHE PA-C
Provider Business Mailing Address
First Line : 2508 33RD AVE SE
Second Line :
City : PUYALLUP
State : WA
Zip : 98374-4131
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3320 AUBURN WAY N
Second Line :
City : AUBURN
State : WA
Zip : 98002-1805
Country : US
Telephone Number : 253-999-5750
Fax Number : 253-999-5740
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/17/2018
Last Update Date : 04/01/2025

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Directions to “ ANDORA RAQUEL AZABACHE PA-C” Practice Location

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