Provider Demographics
NPI:1598435463
Name:ARAGON, LOURDES KIMVERY
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:KIMVERY
Last Name:ARAGON
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 1:202 27TH AVE SE SPC #8
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374
Mailing Address - Country:US
Mailing Address - Phone:425-300-0708
Mailing Address - Fax:
Practice Address - Street 1:202 27TH AVE SE SPC #8
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374
Practice Address - Country:US
Practice Address - Phone:425-300-0708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC15983171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter