Provider Demographics
NPI:1518513548
Name:LOPEZ RAMIREZ, JEYSI ADELINA (MA 60469504)
Entity Type:Individual
Prefix:
First Name:JEYSI
Middle Name:ADELINA
Last Name:LOPEZ RAMIREZ
Suffix:
Gender:F
Credentials:MA 60469504
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15914 44TH AVE W APT G101
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-6160
Mailing Address - Country:US
Mailing Address - Phone:206-953-3594
Mailing Address - Fax:
Practice Address - Street 1:1429 MARKET ST
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033
Practice Address - Country:US
Practice Address - Phone:206-953-3594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60469504225700000X
WAMA60469504225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist