Provider Demographics
NPI:1336345719
Name:CARVAJAL, CARMELA (LMP)
Entity Type:Individual
Prefix:MS
First Name:CARMELA
Middle Name:
Last Name:CARVAJAL
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3623B FRANCIS AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-8516
Mailing Address - Country:US
Mailing Address - Phone:206-354-0043
Mailing Address - Fax:
Practice Address - Street 1:3623B FRANCIS AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8516
Practice Address - Country:US
Practice Address - Phone:206-354-0043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022305225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist