Provider Demographics
NPI:1063014165
Name:SANTOS DIAZ, MASSIEL ALEXANDRA (ARNP)
Entity Type:Individual
Prefix:
First Name:MASSIEL
Middle Name:ALEXANDRA
Last Name:SANTOS DIAZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3007
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98114-3007
Mailing Address - Country:US
Mailing Address - Phone:206-788-3700
Mailing Address - Fax:206-962-3298
Practice Address - Street 1:720 8TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3032
Practice Address - Country:US
Practice Address - Phone:206-788-3700
Practice Address - Fax:206-962-3298
Is Sole Proprietor?:No
Enumeration Date:2020-11-12
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11010165363L00000X
WAAP61173621363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2195338Medicaid