Provider Demographics
NPI:1245401488
Name:CAVADA, DOLORES ERMITANIO
Entity Type:Individual
Prefix:
First Name:DOLORES
Middle Name:ERMITANIO
Last Name:CAVADA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DOLORES
Other - Middle Name:ERMITANIO
Other - Last Name:ZUNIGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1036 S 325TH ST
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-5933
Mailing Address - Country:US
Mailing Address - Phone:253-946-4571
Mailing Address - Fax:253-946-4571
Practice Address - Street 1:1036 S 325TH ST
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5933
Practice Address - Country:US
Practice Address - Phone:253-946-4571
Practice Address - Fax:253-946-4571
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-16
Last Update Date:2008-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA750328311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home