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1040 S Henderson St Seattle WA 98108-4720 | |
| (206) 788-3380 | |
| (206) 788-3393 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 1040 S Henderson St, Seattle, 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: () - | 1040 S Henderson St Seattle WA 98108-4720 Ph: (206) 788-3380 |
| NPI Number | 1114537768 |
|---|---|
| Provider Enumeration Date | 08/07/2020 |
| Last Update Date | 01/31/2025 |
| Certification Date | 01/31/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114537768 | NPI | - | NPPES |
| 2172938 | Medicaid | WA |
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