| Pspc | |
|
10634 E Riverside Dr Suite 130 Bothell WA 98011-3757 | |
| (425) 806-5021 | |
| (425) 486-3949 |
| Full Name | Pspc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 10634 E Riverside Dr, Bothell, Washington |
| Authorized Official Name and Position | Syed Jamal Mustafa (MEDICAL DIRECTOR) |
| Authorized Official Contact | 4258065021 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pspc 10634 E Riverside Dr Suite 130 Bothell WA 98011-3758 Ph: (425) 806-5021 | Pspc 10634 E Riverside Dr Suite 130 Bothell WA 98011-3757 Ph: (425) 806-5021 |
| NPI Number | 1114254729 |
|---|---|
| Provider Enumeration Date | 11/03/2009 |
| Last Update Date | 01/23/2012 |
| Medicare PECOS PAC ID | 4688766066 |
|---|---|
| Medicare Enrollment ID | O20070816000399 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114254729 | NPI | - | NPPES |
| 1112333 | Medicaid | WA |
| Provider Name | Syed J Mustafa |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1609883180 PECOS PAC ID: 2365533544 Enrollment ID: I20070801000767 |
| Provider Name | Syed Kamal Mustafa |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1316954894 PECOS PAC ID: 3375632193 Enrollment ID: I20071203000026 |
| Provider Name | Marcus G Nemuth |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1245337120 PECOS PAC ID: 3678610979 Enrollment ID: I20091019000463 |
| Provider Name | Max H Hines |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1811993983 PECOS PAC ID: 3779668751 Enrollment ID: I20140311000892 |
| Provider Name | Truc Nguyen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154641868 PECOS PAC ID: 3072823855 Enrollment ID: I20151106000619 |
| Provider Name | Dee Dee S Vasquez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205200201 PECOS PAC ID: 3577866227 Enrollment ID: I20160129001204 |
| Provider Name | Wou Sang Han |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548677719 PECOS PAC ID: 8921355439 Enrollment ID: I20180716000478 |
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