| |
2121 S 19th St Tacoma WA 98405-2922 | |
(253) 396-1634 | |
(253) 396-1663 |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 2121 S 19th St, Tacoma, 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 |
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Po Box 34703 Seattle WA 98124-1703 Ph: () - | 2121 S 19th St Tacoma WA 98405-2922 Ph: (253) 396-1634 |
NPI Number | 1710035100 |
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Provider Enumeration Date | 01/08/2007 |
Last Update Date | 01/31/2025 |
Certification Date | 01/31/2025 |
Identifier | Type | State | Issuer |
---|---|---|---|
1710035100 | NPI | - | NPPES |
1017028 | Medicaid | WA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101Y00000X | Counselor | (* (Not Available)) | Secondary |
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 6005372781 (Washington) | Primary |
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