Provider Demographics
NPI:1952854671
Name:MATTIUZ, SANELA (MD)
Entity Type:Individual
Prefix:DR
First Name:SANELA
Middle Name:
Last Name:MATTIUZ
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 1:10634 E RIVERSIDE DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-3757
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10634 E RIVERSIDE DR
Practice Address - Street 2:SUITE 130
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3757
Practice Address - Country:US
Practice Address - Phone:425-806-5021
Practice Address - Fax:425-486-3949
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2084P 0800XOtherTAXONOMY NUMBER