Provider Demographics
NPI:1205581030
Name:LEGASPI, CORAZON FABIAN
Entity type:Individual
Prefix:
First Name:CORAZON
Middle Name:FABIAN
Last Name:LEGASPI
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 1:1813 DAVIS AVE S
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-3313
Mailing Address - Country:US
Mailing Address - Phone:425-336-9646
Mailing Address - Fax:
Practice Address - Street 1:1813 DAVIS AVE S
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-3313
Practice Address - Country:US
Practice Address - Phone:425-336-9646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA755358311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home