1447370366 NPI number — PABLO R PROANO MD PS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447370366 NPI number — PABLO R PROANO MD PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PABLO R PROANO MD PS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1447370366
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17719 PAC AVE S VALLEY WEST BILLING SVC
Provider Second Line Business Mailing Address:
PMB 431
Provider Business Mailing Address City Name:
SPANAWAY
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98387-8334
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-847-9195
Provider Business Mailing Address Fax Number:
253-847-9292

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1229 MADISON ST
Provider Second Line Business Practice Location Address:
STE 1210
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98104-3586
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-386-3103
Provider Business Practice Location Address Fax Number:
206-386-3123
Provider Enumeration Date:
04/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PROANO
Authorized Official First Name:
PABLO
Authorized Official Middle Name:
R
Authorized Official Title or Position:
MD CORPORATE PRESIDENT
Authorized Official Telephone Number:
206-386-3103

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  20243 , 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)

  • Identifier: 1030220 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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