Provider Demographics
NPI:1851961627
Name:VIDRIO EFIGENIO, JOAQUIN
Entity Type:Individual
Prefix:
First Name:JOAQUIN
Middle Name:
Last Name:VIDRIO EFIGENIO
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 1:24510 108TH PL SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-5034
Mailing Address - Country:US
Mailing Address - Phone:360-908-4513
Mailing Address - Fax:
Practice Address - Street 1:24510 108TH PL SE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-5034
Practice Address - Country:US
Practice Address - Phone:360-908-4513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC56666171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter