Provider Demographics
NPI:1265579874
Name:WILSON RODRIGUEZ, RACHEL DAIGH (LAC, LMP)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:DAIGH
Last Name:WILSON RODRIGUEZ
Suffix:
Gender:F
Credentials:LAC, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13643 92ND PL NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-1845
Mailing Address - Country:US
Mailing Address - Phone:425-891-6719
Mailing Address - Fax:
Practice Address - Street 1:8310 165TH AVE NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3907
Practice Address - Country:US
Practice Address - Phone:425-891-6719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002429171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist