Provider Demographics
NPI:1699523068
Name:MIRAMONTES HERNANDEZ, ABRAHAM (MD)
Entity type:Individual
Prefix:MR
First Name:ABRAHAM
Middle Name:
Last Name:MIRAMONTES HERNANDEZ
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 COLBY AVENUE SUITE B400
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201
Mailing Address - Country:US
Mailing Address - Phone:425-297-5234
Mailing Address - Fax:
Practice Address - Street 1:WSU INTERNAL MEDICINE RESIDENCY CENTER
Practice Address - Street 2:1321 COLBY AVENUE #B3-039
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-1665
Practice Address - Country:US
Practice Address - Phone:425-297-5234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-09
Last Update Date:2025-02-24
Deactivation Date:2025-01-10
Deactivation Code:
Reactivation Date:2025-02-24
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAML61565267390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program