Provider Demographics
NPI:1265173793
Name:PEREZ BADILLO, JAIRO
Entity type:Individual
Prefix:
First Name:JAIRO
Middle Name:
Last Name:PEREZ BADILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4702 S 124TH ST
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98178-3450
Mailing Address - Country:US
Mailing Address - Phone:206-454-0909
Mailing Address - Fax:
Practice Address - Street 1:4702 S 124TH ST
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98178-3450
Practice Address - Country:US
Practice Address - Phone:206-454-0909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter