| |
2201 S 19th St Suite 200 Tacoma WA 98405-2962 | |
(253) 627-3547 | |
(253) 272-4771 |
Full Name | |
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Speciality | Psychiatry & Neurology - Neurology |
Location | 2201 S 19th St, Tacoma, Washington |
Authorized Official Name and Position | Angela C Maricle (OFFICE MANAGER) |
Authorized Official Contact | 2536273547 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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2201 S 19th St Suite 200 Tacoma WA 98405-2962 Ph: (253) 627-3547 | 2201 S 19th St Suite 200 Tacoma WA 98405-2962 Ph: (253) 627-3547 |
NPI Number | 1871649285 |
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Provider Enumeration Date | 01/26/2007 |
Last Update Date | 11/17/2009 |
Identifier | Type | State | Issuer |
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1871649285 | NPI | - | NPPES |
13162 | Other | WA | LABOR & INDUSTRIES |
1031178 | Medicaid | WA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
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