Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | MD00041000 | WA |
NPI | 1003843962 |
---|---|
Provider Name | Glaucia Decastro Moreira |
First Address | Burien, WA 98166 |
Second Address | Tacoma, WA 98405-4933 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 18/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0164971 | L&I (01) | |
3127WE | B/S REGENCE 90 (01) | |
8299596 | (05) | WA |
H58827 | (02) |