Provider Demographics
NPI:1639781586
Name:AVELLANEDA LARRIVA, KAREN CARMEN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:CARMEN
Last Name:AVELLANEDA LARRIVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:CARMEN
Other - Last Name:AVELLANEDA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2913 208TH PL SW
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-8953
Mailing Address - Country:US
Mailing Address - Phone:206-355-7463
Mailing Address - Fax:
Practice Address - Street 1:2913 208TH PL SW
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-8953
Practice Address - Country:US
Practice Address - Phone:206-355-7463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC8208171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter