Individual
JORGE ABEL VIZCARRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LD
Contact information
Practice address
12733 LAKE CITY WAY NE STE 301, SEATTLE, WA 98125-4490
(206) 365-5060
(206) 417-3047
Mailing address
12733 LAKE CITY WAY NE STE 301, SEATTLE, WA 98125-4490
(206) 365-5060
(206) 417-3047
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
DN00000259
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DSHS 5057865
DSHS PROVIDER
WA
Enumeration date
09/11/2015
Last updated
09/11/2015
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