Provider Demographics
NPI:1003022112
Name:MARAGH, LETICIA AYALA (ML)
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:AYALA
Last Name:MARAGH
Suffix:
Gender:F
Credentials:ML
Other - Prefix:
Other - First Name:LETICIA
Other - Middle Name:
Other - Last Name:AYALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 34876
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1876
Mailing Address - Country:US
Mailing Address - Phone:425-656-5412
Mailing Address - Fax:425-656-4096
Practice Address - Street 1:7203 129TH AVE SE
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:WA
Practice Address - Zip Code:98056-1412
Practice Address - Country:US
Practice Address - Phone:425-656-5406
Practice Address - Fax:425-656-5040
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60508339207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine