Icayan, Elena Eustaquio

Icayan, Elena Eustaquio is an sole proprietor health care provider with primary practice located at 520 N 4Th Ave , Pasco WA 99301-5257. She recently has only one registered license in Allopathic & Osteopathic Physicians / Nuclear Medicine, which is considered as her primary health care specialty. Icayan, Elena Eustaquio can be contacted via phone (509) 546-2318.

Contact Information

Primary practice address
520 N 4Th Ave Pasco WA 99301-5257
Phone: (509) 546-2318
Fax: (509) 546-2317
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Nuclear Medicine 207U00000X MD00013006 Washington

Profile Details

NPI number 1851386619
LBN Legal business name Icayan, Elena Eustaquio
Credentials MD SCD
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 16th, 2005
Last updated Oct 30th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1851386619 NPPES
Other 0025988 LABOR AND INDUSTRIES
MEDICAID 1409408 LABOR AND INDUSTRIES
MEDICAID 7056005 LABOR AND INDUSTRIES

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