Provider Demographics
NPI:1831764059
Name:AMEZCUA, VICTOR I (MEDICAL INTERPRETER)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:AMEZCUA
Suffix:I
Gender:M
Credentials:MEDICAL INTERPRETER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 S 333RD ST TRLR 108
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6431
Mailing Address - Country:US
Mailing Address - Phone:206-852-1003
Mailing Address - Fax:
Practice Address - Street 1:1660 S 333RD ST TRLR 108
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6431
Practice Address - Country:US
Practice Address - Phone:206-852-1003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC9399171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter