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Individual

MR. MAURICIO JESUS HENRIQUEZ

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LD

Contact information

Practice address
163 164TH AVE SE, BELLEVUE, WA 98008-4637
(425) 417-6091
Mailing address
163 164TH AVE SE, BELLEVUE, WA 98008-4637
(425) 417-6091

Taxonomy

Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
DN00000313
WA

Other

Enumeration date
01/23/2008
Last updated
01/23/2008
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