Individual
ESRAVILA ARIYA WIBISONO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10004 204TH AVE E STE 2200, BONNEY LAKE, WA 98391-6537
(253) 447-3300
Mailing address
10004 204TH AVE E STE 2200, BONNEY LAKE, WA 98391-6537
(253) 447-3300
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD61603415
WA
390200000X
Student in an Organized Health Care Education/Training Program
06-0646844
CT
Other
Enumeration date
06/14/2022
Last updated
07/31/2025
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