Individual
HENRIETTA LORENA MAYUGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
7131 W DESCHUTES AVENUE, SUITE 101, KENNEWICK, WA 99336
(509) 222-1260
(509) 222-1264
Mailing address
7131 W DESCHUTES AVE, SUITE 101, KENNEWICK, WA 99336-7801
(509) 222-1260
(509) 222-1264
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00035419
WA
207V00000X
Obstetrics & Gynecology Physician
MD00035419
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
319211600
MEDICARE GROUP #
WA
05
—
8211757
—
WA
Enumeration date
04/17/2006
Last updated
05/07/2013
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