Provider Demographics
NPI:1912165531
Name:PEREZ CASTRO, MECHELL (LMP)
Entity Type:Individual
Prefix:
First Name:MECHELL
Middle Name:
Last Name:PEREZ CASTRO
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:MECHELL
Other - Middle Name:
Other - Last Name:PINEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:1050 140TH AVE NE
Mailing Address - Street 2:SUITE D
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2972
Mailing Address - Country:US
Mailing Address - Phone:425-688-0223
Mailing Address - Fax:425-688-0323
Practice Address - Street 1:1050 140TH AVE NE
Practice Address - Street 2:SUITE D
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2972
Practice Address - Country:US
Practice Address - Phone:425-688-0223
Practice Address - Fax:425-688-0323
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024935225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist