Provider Demographics
NPI:1629840566
Name:ASENCIO, JULIANA (PA-C)
Entity type:Individual
Prefix:
First Name:JULIANA
Middle Name:
Last Name:ASENCIO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:550 GAGE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-9532
Mailing Address - Country:US
Mailing Address - Phone:509-473-0637
Mailing Address - Fax:509-627-2983
Practice Address - Street 1:780 SWIFT BLVD STE 101
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3545
Practice Address - Country:US
Practice Address - Phone:509-942-3070
Practice Address - Fax:509-942-3167
Is Sole Proprietor?:No
Enumeration Date:2023-10-24
Last Update Date:2024-09-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL9118088363A00000X
WAPA61563108363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant