Provider Demographics
NPI:1851691174
Name:SUWANAKRIT, CATHELIYA B (06/22/2010 NAR)
Entity Type:Individual
Prefix:MISS
First Name:CATHELIYA
Middle Name:B
Last Name:SUWANAKRIT
Suffix:
Gender:F
Credentials:06/22/2010 NAR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22400 87TH AVE W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-8224
Mailing Address - Country:US
Mailing Address - Phone:206-491-1337
Mailing Address - Fax:
Practice Address - Street 1:3156 SPORTS ARENA BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110
Practice Address - Country:US
Practice Address - Phone:619-569-3260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5792225700000X
WANA 60157699374U00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
WANA 60157699OtherNURSING ASSISTANT REGISTRATION