1770920597 NPI number — ANASTASIA SERGEEVNA HEINS PA-C

Table of content: DR. JESUS ALBERTO GONZALEZ SOLORZANO PHARMD (NPI 1841167459)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770920597 NPI number — ANASTASIA SERGEEVNA HEINS PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEINS
Provider First Name:
ANASTASIA
Provider Middle Name:
SERGEEVNA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RODIONOVA
Provider Other First Name:
ANASTASIA
Provider Other Middle Name:
SERGEEVNA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1770920597
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1708 YAKIMA AVE
Provider Second Line Business Mailing Address:
STE 105
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98405-5307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-426-4420
Provider Business Mailing Address Fax Number:
253-426-4383

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1708 YAKIMA AVE
Provider Second Line Business Practice Location Address:
STE 105
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98405-5307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-426-4420
Provider Business Practice Location Address Fax Number:
253-426-4383
Provider Enumeration Date:
06/03/2013

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: 363AS0400X , with the licence number:  PA60351859 , 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: 0312567 . This is a "L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: G8920923 . This is a "MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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