Individual
AZALIA ACOSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
425 E MAIN ST STE 600, OTHELLO, WA 99344-1146
(509) 488-4074
Mailing address
425 E MAIN ST STE 600, OTHELLO, WA 99344-1146
(509) 488-4074
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
CG60941622
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CG60941622
AGENCY AFFILIATION REGISTRATION
WA
Enumeration date
03/22/2019
Last updated
03/22/2019
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