Provider Demographics
NPI:1215517461
Name:VALENZUELA SEPULVEDA, TRINIDAD CAMILA (CMI-SPANISH)
Entity type:Individual
Prefix:
First Name:TRINIDAD
Middle Name:CAMILA
Last Name:VALENZUELA SEPULVEDA
Suffix:
Gender:F
Credentials:CMI-SPANISH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4902 6TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-3537
Mailing Address - Country:US
Mailing Address - Phone:312-874-9177
Mailing Address - Fax:
Practice Address - Street 1:4902 6TH AVE NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3537
Practice Address - Country:US
Practice Address - Phone:312-874-9177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA103161171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter