Individual
KEVIN JHORDAN MORENO VAZQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9040 JACKSON AVE, ATTN: MCHJ-CLQ-C, TACOMA, WA 98433
(253) 986-0982
Mailing address
767 141ST STREET CT S, TACOMA, WA 98444-3398
(678) 622-0318
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
337386
TX
Other
Enumeration date
10/15/2018
Last updated
10/15/2018
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