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228 W 1st St Ste L Port Angeles WA 98362-2640 | |
| (360) 406-5260 | |
| (360) 406-5275 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 228 W 1st St Ste L, Port Angeles, Washington |
| Authorized Official Name and Position | Rogelio Riojas (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2067883226 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 34703 Seattle WA 98124-1703 Ph: () - | 228 W 1st St Ste L Port Angeles WA 98362-2640 Ph: (360) 406-5260 |
| NPI Number | 1851730691 |
|---|---|
| Provider Enumeration Date | 06/14/2013 |
| Last Update Date | 01/31/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851730691 | NPI | - | NPPES |
| 2035200 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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