Provider Demographics
NPI:1710594429
Name:HERRERA GUANDIQUE, RODOLFO ALEJANDRO
Entity Type:Individual
Prefix:
First Name:RODOLFO
Middle Name:ALEJANDRO
Last Name:HERRERA GUANDIQUE
Suffix:
Gender:M
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 1972
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-1972
Mailing Address - Country:US
Mailing Address - Phone:360-429-9392
Mailing Address - Fax:
Practice Address - Street 1:1608 N 26TH ST APT 106
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-2787
Practice Address - Country:US
Practice Address - Phone:360-429-9392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-26
Last Update Date:2020-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA604589825171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter