Individual
KUSUMA LATHA AYITHEPALLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1221 MADISON ST STE 1220, SEATTLE, WA 98104-1356
(206) 215-4250
(206) 215-4252
Mailing address
PO BOX 25608, SALT LAKE CITY, UT 84125-0608
(206) 320-4476
(206) 568-7043
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA61137144
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1952950958
—
WA
Enumeration date
09/11/2019
Last updated
01/17/2022
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