Provider Demographics
NPI:1902413008
Name:URIBE, KATRINA V
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:V
Last Name:URIBE
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 1:4303 WOODLAND PARK AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-7426
Mailing Address - Country:US
Mailing Address - Phone:208-640-9465
Mailing Address - Fax:
Practice Address - Street 1:4303 WOODLAND PARK AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-7426
Practice Address - Country:US
Practice Address - Phone:208-640-9465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist