Provider Demographics
NPI:1013132745
Name:MALDONADO, LIZETTE LAVONNE (RNA,LMP)
Entity type:Individual
Prefix:MRS
First Name:LIZETTE
Middle Name:LAVONNE
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:RNA,LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12833 ASHWORTH AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-7622
Mailing Address - Country:US
Mailing Address - Phone:206-353-7855
Mailing Address - Fax:206-306-0506
Practice Address - Street 1:12833 ASHWORTH AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-7622
Practice Address - Country:US
Practice Address - Phone:206-353-7855
Practice Address - Fax:206-306-0506
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA024201MA00013983225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist