Individual
ANDRES DIEZCANSECO MALLIPUDI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
202 N DIVISION ST, AUBURN, WA 98001-4939
(800) 225-0953
Mailing address
202 N DIVISION ST, AUBURN, WA 98001-4939
(800) 225-0953
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
292098
MA
207P00000X
Emergency Medicine Physician
Primary
MD61518915
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110187275A
—
MA
05
—
3134859
—
NH
Enumeration date
02/05/2015
Last updated
10/01/2024
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