Provider Demographics
NPI:1710292016
Name:AHJJIZZ, CYIERRA'VYAMENA L
Entity Type:Individual
Prefix:
First Name:CYIERRA'VYAMENA
Middle Name:L
Last Name:AHJJIZZ
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:PO BOX 5685
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98046-5685
Mailing Address - Country:US
Mailing Address - Phone:425-268-3722
Mailing Address - Fax:206-522-4003
Practice Address - Street 1:460 NE 70TH
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115
Practice Address - Country:US
Practice Address - Phone:206-522-4000
Practice Address - Fax:206-522-4003
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022342225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist