Provider Demographics
NPI:1104127190
Name:MEDEIROS, CARINA TERESE (EAMP)
Entity type:Individual
Prefix:
First Name:CARINA
Middle Name:TERESE
Last Name:MEDEIROS
Suffix:
Gender:F
Credentials:EAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 N 72ND ST
Mailing Address - Street 2:APT C
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-5048
Mailing Address - Country:US
Mailing Address - Phone:206-794-0354
Mailing Address - Fax:
Practice Address - Street 1:310 N 72ND ST
Practice Address - Street 2:APT C
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-5048
Practice Address - Country:US
Practice Address - Phone:206-794-0354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC 60191715171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist