Provider Demographics
NPI:1447602107
Name:BARAYUGA, MELCHORA BONILLA
Entity Type:Individual
Prefix:
First Name:MELCHORA
Middle Name:BONILLA
Last Name:BARAYUGA
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:MADIGAN ANNEX 2ND FLOOR BLDG 9900
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-0001
Mailing Address - Country:US
Mailing Address - Phone:253-967-1213
Mailing Address - Fax:253-967-7216
Practice Address - Street 1:MADIGAN ANNEX 2ND FLOOR BLDG 9900
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:253-967-1213
Practice Address - Fax:253-967-7216
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant