Provider Demographics
NPI:1760936843
Name:CARLES, VERONICA COROMOTO
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:COROMOTO
Last Name:CARLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:COROMOTO
Other - Last Name:CARLES PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7458 NW 99TH CT
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-3429
Mailing Address - Country:US
Mailing Address - Phone:206-883-8310
Mailing Address - Fax:
Practice Address - Street 1:12410 NE 24TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-1530
Practice Address - Country:US
Practice Address - Phone:206-883-8319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-07
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1043838133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WANPI: 1205214889OtherEVERGREEN HEALTH