Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | MD00025780 | WA |
NPI | 1174518245 |
---|---|
Provider Name | Graciela Del Rio |
First Address | Renton, WA 98055-5791 |
Second Address | Renton, WA 98055-5791 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1059138 | (05) | WA |
DE5931 | REGENCE (01) | WA |