Provider Demographics
NPI:1235553579
Name:CHAVEZ, TIERRA SOLANA (LMP)
Entity Type:Individual
Prefix:
First Name:TIERRA SOLANA
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 NE 169TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-6042
Mailing Address - Country:US
Mailing Address - Phone:206-361-1151
Mailing Address - Fax:
Practice Address - Street 1:1507 NE 169TH ST APT 2
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-6042
Practice Address - Country:US
Practice Address - Phone:206-361-1151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60442127225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist