Provider Demographics
NPI:1568917706
Name:LET, CARMEN DIANA I (LMP)
Entity Type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:DIANA
Last Name:LET
Suffix:I
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 1:31845 18TH AVE SW APT A
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-5156
Mailing Address - Country:US
Mailing Address - Phone:206-249-5836
Mailing Address - Fax:
Practice Address - Street 1:31845 18TH AVE SW APT A
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-5156
Practice Address - Country:US
Practice Address - Phone:206-249-5836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60632461225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist