Provider Demographics
NPI:1851874028
Name:GARCIA MALDONADO, BRISDELI
Entity Type:Individual
Prefix:MISS
First Name:BRISDELI
Middle Name:
Last Name:GARCIA MALDONADO
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 1:907 HARRINGTON AVE NE APT 4
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-3076
Mailing Address - Country:US
Mailing Address - Phone:206-259-0023
Mailing Address - Fax:
Practice Address - Street 1:10242 16TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98146-1432
Practice Address - Country:US
Practice Address - Phone:206-764-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60871099225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist