JAIRO ENRIGUE MENDOZA BRICENO (NPI# 1982227062) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982227062 |
| Entity Type | Individual |
| Full Name | JAIRO ENRIGUE MENDOZA BRICENO |
| Credential | M.D. |
| Practice Address |
525 Lilly Rd Ne Suite 204 Olympia WA 98506-5101 |
| Mailing Address |
525 Lilly Rd Ne Suite 204 Olympia WA 98506 |
| Practice Telephone | 3064937230 |
| Practice Fax Number | 3604934180 |
| Mailing Telephone | 3064937230 |
| Mailing Fax Number | 3604934180 |
| Enumeration Date | 2020-05-22 |
| Last Update Date | 2020-09-25 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Street Address |
525 LILLY RD NE SUITE 204 |
| City | OLYMPIA |
| State | WA |
| Zip Code | 98506-5101 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861493884 | Suzanne Ellen Woodsum-reed | Social Worker | 525 Lilly Rd Ne, Olympia, WA 98506-5101 | 2005-08-02 |
| 1730702432 | Chanel Wood | Student in an Organized Health Care Education/Training Program | 525 Lilly Rd Ne, Suite 204, Olympia, WA 98506 | 2020-05-28 |
| 1598384901 | Junun Bae | Student in an Organized Health Care Education/Training Program | 525 Lilly Rd Ne, Olympia, WA 98506-5101 | 2020-04-15 |
| 1205484813 | Neighborcare Health | Clinic/Center | 525 Lilly Rd Ne, Olympia, WA 98506-5101 | 2019-08-27 |
| 1972158210 | Erik Gilbert Gunderson | Pharmacist | 525 Lilly Rd Ne, Olympia, WA 98506-5101 | 2019-08-05 |
| 1215595509 | Hieu Thi Minh Duong | Family Medicine | 525 Lilly Rd Ne, Olympia, WA 98506-5101 | 2019-05-31 |
| 1255998324 | Fang-yu Lee | Family Medicine | 525 Lilly Rd Ne, Olympia, WA 98506-5101 | 2019-05-23 |
| 1588221642 | Jennifer Jean Goodrich | Family Medicine | 525 Lilly Rd Ne, Olympia, WA 98506-5101 | 2019-05-23 |
| 1831756998 | Ryan Edel Kuhar | Family Medicine | 525 Lilly Rd Ne, Olympia, WA 98506-5101 | 2019-05-23 |
| 1578120630 | Kimberly Alyse Britsch | Family Medicine | 525 Lilly Rd Ne, Olympia, WA 98506-5101 | 2019-05-23 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477185460 | Chloe Harper | Technician, Other | 3443 Lilly Rd Se, Ste B, Olympia, WA 98506 | 2020-02-07 |
| 1912543539 | Jessica Marie Radakovich | Licensed Practical Nurse | 3426 Mary Elder Rd, Olympia, WA 98506 | 2019-11-19 |
| 1669014973 | Arlene Josephine Adams | Registered Nurse | 413 Lily Rd Ne, Olympia, WA 98506 | 2019-10-09 |
| 1861999120 | Debra Delores Barker | Licensed Practical Nurse | 3710 South Bay Rd Ne, Olympia, WA 98506 | 2018-04-12 |
| 1801304431 | Michelle Warner | Nurse Practitioner | 205 Lilly Rd Ne Ste A1, Olympia, WA 98506 | 2018-01-17 |
| 1396258364 | Institute for Family Development | Community/Behavioral Health | 204 Quince St. Ne, Suite 200, Olympia, WA 98506 | 2017-11-13 |
| 1083137715 | Cameron Kunkel | Specialist/Technologist | 2512 20th Ave Ne, Olympia, WA 98506 | 2017-07-25 |
| 1184144768 | Trevor Shane Kwan | Family Medicine | 525 Lilly Road Ne, Olympia, WA 98506 | 2017-06-23 |
| 1073043212 | Michael H Harburg | Behavior Technician | 3857 Martin Way Ne, Olympia, WA 98506 | 2017-06-19 |
| 1780114371 | Priscilla Kangyang Jadu | Counselor | 3857 Martin Way E., Olympia, WA 98506 | 2017-06-15 |
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| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346850070 | Daniel Muro | Student in an Organized Health Care Education/Training Program | 1318 Neil St Ne, Olympia, WA 98516-5532 | 2020-08-06 |
| 1942827035 | Olivia Anne Harris-bloom | Student in an Organized Health Care Education/Training Program | 300 Kenyon St Nw Apt G4, Olympia, WA 98502-2770 | 2020-07-06 |
| 1003443789 | Thu Le | Student in an Organized Health Care Education/Training Program | 1808 Meixner St Ne, Olympia, WA 98506-3567 | 2020-03-24 |
| 1205493996 | David Lin | Student in an Organized Health Care Education/Training Program | 3530 32nd Way Nw, Olympia, WA 98502-3230 | 2019-05-29 |
| 1821588039 | Namgu Kim | Student in an Organized Health Care Education/Training Program | 11321 Scott Creek Dr Sw, Olympia, WA 98512-9036 | 2018-05-14 |
| 1184072480 | Tracy Ta | Student in an Organized Health Care Education/Training Program | 4535 Trenton Loop Se, Olympia, WA 98501-4800 | 2016-05-26 |
| 1669784633 | Lindy Marie Holmes | Student in an Organized Health Care Education/Training Program | 8120 61st Ave Ne, Olympia, WA 98516-9140 | 2010-07-07 |
| 1780292714 | Paola Von Oelffen | Student in an Organized Health Care Education/Training Program | 413 Lilly Rd Ne, Olympia, WA 98506-5133 | 2020-07-15 |
| 1730702432 | Chanel Wood | Student in an Organized Health Care Education/Training Program | 525 Lilly Rd Ne, Suite 204, Olympia, WA 98506 | 2020-05-28 |
| 1346861150 | Joshua Lee Wixwat | Student in an Organized Health Care Education/Training Program | 525 Lilly Rd Ne Ste 204, Olympia, WA 98506-5101 | 2020-05-04 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.