Basic Information
Provider Information
NPI: 1902485279
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SANCHEZ
FirstName: KATIA
MiddleName: JAILENE
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
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OtherCredential:  
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Mailing Information
Address1: 1210 SW 136TH ST
Address2:  
City: BURIEN
State: WA
PostalCode: 981661214
CountryCode: US
TelephoneNumber: 2062576600
FaxNumber:  
Practice Location
Address1: 1210 SW 136TH ST
Address2:  
City: BURIEN
State: WA
PostalCode: 981661214
CountryCode: US
TelephoneNumber: 2062576600
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/05/2021
LastUpdateDate: 04/05/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/05/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
246RP1900X61152144WAY Technologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy

No ID Information.


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