Provider Demographics
NPI:1396551180
Name:RIBEIRO FERREIRA, THALLES FERNANDO
Entity type:Individual
Prefix:MR
First Name:THALLES FERNANDO
Middle Name:
Last Name:RIBEIRO FERREIRA
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 1:4111 E MADISON ST STE 2
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-3241
Mailing Address - Country:US
Mailing Address - Phone:425-480-8863
Mailing Address - Fax:
Practice Address - Street 1:4111 E MADISON ST STE 2
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-3241
Practice Address - Country:US
Practice Address - Phone:425-480-8863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator