1073610465 NPI number — MRS. CONSTANCE ROSARIO RAINWATER CDP

Table of content: MRS. CONSTANCE ROSARIO RAINWATER CDP (NPI 1073610465)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073610465 NPI number — MRS. CONSTANCE ROSARIO RAINWATER CDP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAINWATER
Provider First Name:
CONSTANCE
Provider Middle Name:
ROSARIO
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CDP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073610465
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3801 NE 9TH CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RENTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98056-3814
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-271-5552
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PUGET SOUND HEALTH CARE SYSTEM (MHC116)
Provider Second Line Business Practice Location Address:
1660 S COLUMBIAN WAY
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-277-3307
Provider Business Practice Location Address Fax Number:
206-764-2572
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  RC00004778 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com