Provider Demographics
NPI:1508578865
Name:MUNOZ JUAREZ, BLANCA NAYELY
Entity Type:Individual
Prefix:
First Name:BLANCA NAYELY
Middle Name:
Last Name:MUNOZ JUAREZ
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 1:4228 213TH PL SE # 26
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-9700
Mailing Address - Country:US
Mailing Address - Phone:425-654-9064
Mailing Address - Fax:
Practice Address - Street 1:1445 NW MALL ST STE 2
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-7900
Practice Address - Country:US
Practice Address - Phone:206-380-3009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician