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25028 104th Ave Se Kent WA 98030-9310 | |
| (206) 764-8019 | |
| (253) 480-2937 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 25028 104th Ave Se, Kent, Washington |
| Authorized Official Name and Position | Rogelio Riojas (CEO) |
| Authorized Official Contact | 2067635277 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 34703 Seattle WA 98124-1703 Ph: () - | 25028 104th Ave Se Kent WA 98030-9310 Ph: (206) 764-8019 |
| NPI Number | 1710035449 |
|---|---|
| Provider Enumeration Date | 01/08/2007 |
| Last Update Date | 01/31/2025 |
| Certification Date | 01/31/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710035449 | NPI | - | NPPES |
| 1017029 | Medicaid | WA |
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