Provider Demographics
NPI:1770511735
Name:QUIJADA, VILMA E (MD)
Entity Type:Individual
Prefix:
First Name:VILMA
Middle Name:E
Last Name:QUIJADA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24920 104TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-6443
Mailing Address - Country:US
Mailing Address - Phone:425-690-3544
Mailing Address - Fax:425-690-9444
Practice Address - Street 1:24920 104TH AVE SE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-6443
Practice Address - Country:US
Practice Address - Phone:425-690-3544
Practice Address - Fax:425-690-9444
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC20703207RN0300X
WAMD00034300207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA119381OtherLABOR IND
WA119381OtherLABOR IND
8869627Medicare PIN
G38296Medicare UPIN