Provider Demographics
NPI:1609626944
Name:URIOSTEGUI, MARVELI
Entity Type:Individual
Prefix:
First Name:MARVELI
Middle Name:
Last Name:URIOSTEGUI
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 1:2720 S QUILLAN ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99337-2404
Mailing Address - Country:US
Mailing Address - Phone:509-987-2031
Mailing Address - Fax:509-585-9653
Practice Address - Street 1:2720 S QUILLAN ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99337-2404
Practice Address - Country:US
Practice Address - Phone:509-585-8314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADO60399022156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician