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Individual

MARIYA KHOMLYAK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NAR

Contact information

Practice address
2111 SHATTUCK PL S, RENTON, WA 98055-4289
(425) 277-0452
(425) 271-1107
Mailing address
2111 SHATTUCK PL S, RENTON, WA 98055-4289
(425) 277-0452
(425) 271-1107

Taxonomy

Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
750970
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
156016
SOCIAL SERVICE PAYMENT SYSTEM NUMBER
WA
Enumeration date
12/15/2014
Last updated
12/15/2014
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