Provider Demographics
NPI:1881439933
Name:MOCHYLO, ROMAN
Entity type:Individual
Prefix:MR
First Name:ROMAN
Middle Name:
Last Name:MOCHYLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24725 102ND PL SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-5185
Mailing Address - Country:US
Mailing Address - Phone:206-304-0262
Mailing Address - Fax:253-277-0062
Practice Address - Street 1:24725 102ND PL SE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-5185
Practice Address - Country:US
Practice Address - Phone:206-304-0262
Practice Address - Fax:253-277-0062
Is Sole Proprietor?:No
Enumeration Date:2024-06-29
Last Update Date:2024-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA756703374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide