Provider Demographics
NPI:1194574632
Name:AGUILAR ESTRADA, YNGRID (LMT)
Entity type:Individual
Prefix:
First Name:YNGRID
Middle Name:
Last Name:AGUILAR ESTRADA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 S UNION AVE STE B2
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1907
Mailing Address - Country:US
Mailing Address - Phone:253-507-4631
Mailing Address - Fax:253-507-4672
Practice Address - Street 1:1310 S UNION AVE STE B2
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1907
Practice Address - Country:US
Practice Address - Phone:253-507-4631
Practice Address - Fax:253-507-4672
Is Sole Proprietor?:No
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61363114225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist