Individual
JENNIFER L AVILA-SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
27500 168TH PL SE, COVINGTON, WA 98042-5563
(425) 690-3430
(425) 690-9430
Mailing address
3600 LIND AVE SW, SUITE 100 ATTN CREDENTIALING, RENTON, WA 98057-4970
(425) 690-2715
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OP60490848
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2020094
—
WA
01
—
G8942997
MEDICARE W VALLEY MEDICAL GROUP - RENTON
WA
Enumeration date
06/19/2012
Last updated
05/05/2021
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