Provider Demographics
NPI:1245832674
Name:TAGIRVAA, BYAMBASUREN
Entity type:Individual
Prefix:
First Name:BYAMBASUREN
Middle Name:
Last Name:TAGIRVAA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28705 34TH AVE S APT J304
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98001-1015
Mailing Address - Country:US
Mailing Address - Phone:213-326-5903
Mailing Address - Fax:
Practice Address - Street 1:1700 S 305TH PL # A
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-4814
Practice Address - Country:US
Practice Address - Phone:253-941-8275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61029142225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist