Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | LH00008874 | WA |
N | 363LA2200X | Nurse Practitioner - Adult Health | AP30007841 | WA |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP30007841 | WA |
NPI | 1033384987 |
---|---|
Provider Name | Dr. Jose Agustin Pares-Avila |
First Address | Seattle, WA 98145-5095 |
Second Address | Seattle, WA 98104-2420 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2008 |
Last Update Date | 13/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1033384987 | (05) | WA |