Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 024201MA00013983 | WA |
NPI | 1013132745 |
---|---|
Provider Name | Mrs. Lizette Lavonne Maldonado |
First Address | Seattle, WA 98133-7622 |
Second Address | Seattle, WA 98133-7622 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2007 |
Last Update Date | 08/07/2007 |