Provider Demographics
NPI:1205588035
Name:MIRAFLOR, JOSEPH (PROVIDER)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:MIRAFLOR
Suffix:
Gender:M
Credentials:PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11211 74TH AVE E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-4683
Mailing Address - Country:US
Mailing Address - Phone:253-285-5995
Mailing Address - Fax:
Practice Address - Street 1:3217 S KENYON ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-4049
Practice Address - Country:US
Practice Address - Phone:253-205-7890
Practice Address - Fax:206-485-7084
Is Sole Proprietor?:No
Enumeration Date:2022-01-23
Last Update Date:2022-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA755228376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA842892036OtherPRIVATE CLIENTS
WA842892036Medicaid