Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | MD60823477 | WA |
N | 2084N0400X | Neurologist | 04-34526 | KS |
N | 2084N0400X | Neurologist | 2006-0403 | NM |
N | 2084N0400X | Neurologist | MD60823477 | WA |
N | 2084N0402X | Child Neurologist | 04-34526 | KS |
N | 2084N0600X | Clinical Neurophysiologist | 04-34526 | KS |
NPI | 1568501559 |
---|---|
Provider Name | Emmanuel Owen Arseni Picache Martinez |
First Address | Burien, WA 98166-3059 |
Second Address | Burien, WA 98166-3059 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 07/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2116907 | (05) | WA |