Provider Demographics
NPI:1801469945
Name:LUGO URETA, GLAFIRA
Entity type:Individual
Prefix:
First Name:GLAFIRA
Middle Name:
Last Name:LUGO URETA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GLAFIRA
Other - Middle Name:LUGO
Other - Last Name:WALLACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11317 B ST S
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98444-5519
Mailing Address - Country:US
Mailing Address - Phone:253-534-5220
Mailing Address - Fax:253-220-2479
Practice Address - Street 1:11317 B ST S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-5519
Practice Address - Country:US
Practice Address - Phone:253-534-5220
Practice Address - Fax:253-220-2479
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC11422171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171R00000XOther Service ProvidersInterpreterGroup - Single Specialty