Provider Demographics
NPI:1528673001
Name:GLEZFRES, XOATLAXOPEUHTZIN (MC55245, SC11871)
Entity type:Individual
Prefix:MS
First Name:XOATLAXOPEUHTZIN
Middle Name:
Last Name:GLEZFRES
Suffix:
Gender:F
Credentials:MC55245, SC11871
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12340 NE 115TH PL APT 404
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-4480
Mailing Address - Country:US
Mailing Address - Phone:206-718-2684
Mailing Address - Fax:
Practice Address - Street 1:12340 NE 115TH PL APT 404
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-4480
Practice Address - Country:US
Practice Address - Phone:206-718-2684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter