Provider Demographics
NPI:1033227814
Name:RICHARDS, JENNIFER LIZARRAGA (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LIZARRAGA
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 112TH AVE NE
Mailing Address - Street 2:#B250
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3732
Mailing Address - Country:US
Mailing Address - Phone:206-386-9500
Mailing Address - Fax:206-576-3802
Practice Address - Street 1:1200 112TH AVE NE
Practice Address - Street 2:#B250
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3732
Practice Address - Country:US
Practice Address - Phone:206-386-9500
Practice Address - Fax:206-576-3802
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044350207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8428021Medicaid
WA8428021Medicaid
8851546Medicare ID - Type Unspecified