Provider Demographics
NPI:1619587185
Name:ESTAVILLO-CHAVEZ, SUSANA LETICIA
Entity Type:Individual
Prefix:
First Name:SUSANA
Middle Name:LETICIA
Last Name:ESTAVILLO-CHAVEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUSANA
Other - Middle Name:
Other - Last Name:ESTAVILLO-CHAVEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12526 28TH AVE W
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-5488
Mailing Address - Country:US
Mailing Address - Phone:206-251-5393
Mailing Address - Fax:425-348-7372
Practice Address - Street 1:12526 28TH AVE W
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-5488
Practice Address - Country:US
Practice Address - Phone:206-251-5393
Practice Address - Fax:425-348-7372
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-08
Last Update Date:2020-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter