Provider Demographics
NPI:1659981413
Name:VALENCIA, LAILA MEZA (CMI)
Entity Type:Individual
Prefix:
First Name:LAILA
Middle Name:MEZA
Last Name:VALENCIA
Suffix:
Gender:F
Credentials:CMI
Other - Prefix:
Other - First Name:LAILA
Other - Middle Name:
Other - Last Name:VALENCIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CMI
Mailing Address - Street 1:19019 INTERNATIONAL BLVD # 103
Mailing Address - Street 2:
Mailing Address - City:SEATAC
Mailing Address - State:WA
Mailing Address - Zip Code:98188-5207
Mailing Address - Country:US
Mailing Address - Phone:206-852-7089
Mailing Address - Fax:
Practice Address - Street 1:2246 S 132ND ST
Practice Address - Street 2:
Practice Address - City:SEATAC
Practice Address - State:WA
Practice Address - Zip Code:98168-3059
Practice Address - Country:US
Practice Address - Phone:206-852-7089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA9225171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA398998OtherWA LNI