Basic Information
| Provider Information | |||||||||
| NPI: | 1285119636 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LUONGO | ||||||||
| FirstName: | MINA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 325 9TH AVE # MS 359797 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981042499 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2067449656 | ||||||||
| FaxNumber: | 2067449914 | ||||||||
| Practice Location | |||||||||
| Address1: | 325 9TH AVE # MS 359797 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981042499 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2067449656 | ||||||||
| FaxNumber: | 2067449914 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2018 | ||||||||
| LastUpdateDate: | 10/02/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0809X | LUON301144 | WA | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Adult |
No ID Information.