Basic Information
| Provider Information | |||||||||
| NPI: | 1457917890 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ESPARZA | ||||||||
| FirstName: | PETRA | ||||||||
| MiddleName: | ASUNCION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3213 W WHEELER ST # 302 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981993245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2064594882 | ||||||||
| FaxNumber: | 2064535094 | ||||||||
| Practice Location | |||||||||
| Address1: | 1570 WILMINGTON DR STE 220 | ||||||||
| Address2: | |||||||||
| City: | DUPONT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983278773 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2064534882 | ||||||||
| FaxNumber: | 5094206453 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2019 | ||||||||
| LastUpdateDate: | 05/10/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | Y | 193400000X SINGLE SPECIALTY GROUP |
No ID Information.