Provider Demographics
NPI:1528401593
Name:JORGA, SISAY S (LMP)
Entity Type:Individual
Prefix:
First Name:SISAY
Middle Name:S
Last Name:JORGA
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12048 32ND AVE NE APT 304
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-5543
Mailing Address - Country:US
Mailing Address - Phone:206-407-4914
Mailing Address - Fax:
Practice Address - Street 1:16418 7TH PL W STE B
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-8100
Practice Address - Country:US
Practice Address - Phone:425-741-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60324977174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist