Provider Demographics
NPI:1871104398
Name:LANDAVERDE, MARIA CONCEPCION (MEDICAL INTERPRETER)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:CONCEPCION
Last Name:LANDAVERDE
Suffix:
Gender:F
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 1:4113 SW 321ST ST
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-2414
Mailing Address - Country:US
Mailing Address - Phone:253-250-5547
Mailing Address - Fax:206-260-7287
Practice Address - Street 1:4113 SW 321ST ST
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-2414
Practice Address - Country:US
Practice Address - Phone:253-250-5547
Practice Address - Fax:206-260-7287
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA14920171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAWDLBPN61C23BOtherDRIVER LICENSE
WA14920OtherDSHS INTERPRETER CERTIFICATION