Provider Demographics
NPI:1033793609
Name:DEVICTORIA, CARLOTA PERALTA
Entity Type:Individual
Prefix:
First Name:CARLOTA
Middle Name:PERALTA
Last Name:DEVICTORIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2128 SW HOLDEN ST APT C208
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106-3461
Mailing Address - Country:US
Mailing Address - Phone:808-372-2645
Mailing Address - Fax:
Practice Address - Street 1:2600 SW HOLDEN ST # C-208
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-3505
Practice Address - Country:US
Practice Address - Phone:206-933-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61146799163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse