Provider Demographics
NPI:1801085592
Name:GOMEZ,PINEDA, JACQUELINE (LMP)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:
Last Name:GOMEZ,PINEDA
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 1:8204 S 124TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98178-4930
Mailing Address - Country:US
Mailing Address - Phone:425-445-0491
Mailing Address - Fax:206-772-1163
Practice Address - Street 1:3900 FACTORIA BLVD SE
Practice Address - Street 2:FACTORIA PLAZA SUITE #1
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1234
Practice Address - Country:US
Practice Address - Phone:425-445-0491
Practice Address - Fax:206-772-1163
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020125174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist