Provider Demographics
NPI:1164295960
Name:CAZARES ESPINOSA, SELENE M
Entity Type:Individual
Prefix:
First Name:SELENE
Middle Name:M
Last Name:CAZARES ESPINOSA
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 1:3224 BEACON AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-6331
Mailing Address - Country:US
Mailing Address - Phone:253-285-3812
Mailing Address - Fax:
Practice Address - Street 1:8720 14TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-4807
Practice Address - Country:US
Practice Address - Phone:206-762-3730
Practice Address - Fax:206-764-0523
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator