Provider Demographics
NPI:1346836731
Name:AVELLANEDA, CID DEAN
Entity type:Individual
Prefix:
First Name:CID
Middle Name:DEAN
Last Name:AVELLANEDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 188TH ST NW
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-8325
Mailing Address - Country:US
Mailing Address - Phone:425-346-8910
Mailing Address - Fax:
Practice Address - Street 1:1905 188TH ST NW
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8325
Practice Address - Country:US
Practice Address - Phone:425-346-8910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-19
Last Update Date:2020-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC12734171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter