1447370366 NPI number — PABLO R PROANO MD PS

Table of content: (NPI 1447370366)

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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