Provider Demographics
NPI:1447588215
Name:MURTAZINA, DILBAR
Entity Type:Individual
Prefix:
First Name:DILBAR
Middle Name:
Last Name:MURTAZINA
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 1:7600 142ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-4118
Mailing Address - Country:US
Mailing Address - Phone:425-785-5518
Mailing Address - Fax:425-869-6056
Practice Address - Street 1:7600 142ND AVE NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-4118
Practice Address - Country:US
Practice Address - Phone:425-785-5518
Practice Address - Fax:425-869-6056
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-06
Last Update Date:2009-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANU 60104624133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist