Provider Demographics
NPI:1164896163
Name:LOINA, JUAN (PTA)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:LOINA
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 3RD AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-3008
Mailing Address - Country:US
Mailing Address - Phone:206-447-2228
Mailing Address - Fax:206-447-2228
Practice Address - Street 1:1218 3RD AVE STE 104
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-3008
Practice Address - Country:US
Practice Address - Phone:206-447-2228
Practice Address - Fax:206-447-2228
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-14
Last Update Date:2015-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP1 60265714171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator