Provider Demographics
NPI:1063427631
Name:EMMAL FELIPE ENTERPRISES LLC
Entity type:Organization
Organization Name:EMMAL FELIPE ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:EMMAL
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:253-735-2777
Mailing Address - Street 1:1340 M ST SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-6755
Mailing Address - Country:US
Mailing Address - Phone:253-735-2777
Mailing Address - Fax:
Practice Address - Street 1:1340 M ST SE
Practice Address - Street 2:SUITE A
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-6755
Practice Address - Country:US
Practice Address - Phone:253-735-2777
Practice Address - Fax:253-735-4153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2024-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007144207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAQ59921Medicare UPIN