Provider Demographics
NPI:1326482936
Name:PACHECO SALVATIERRA, MILVIA BARENICE (MA60320887)
Entity Type:Individual
Prefix:
First Name:MILVIA
Middle Name:BARENICE
Last Name:PACHECO SALVATIERRA
Suffix:
Gender:F
Credentials:MA60320887
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9456 18TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106-2716
Mailing Address - Country:US
Mailing Address - Phone:206-852-7456
Mailing Address - Fax:
Practice Address - Street 1:15245 INTERNATIONAL BLVD STE 210
Practice Address - Street 2:
Practice Address - City:SEATAC
Practice Address - State:WA
Practice Address - Zip Code:98188-2233
Practice Address - Country:US
Practice Address - Phone:206-923-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-25
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60320887172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker