| |
31405 18th Ave S Federal Way WA 98003-5433 | |
(253) 681-6640 | |
(253) 681-6631 |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 31405 18th Ave S, Federal Way, 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: () - | 31405 18th Ave S Federal Way WA 98003-5433 Ph: (253) 681-6640 |
NPI Number | 1023550613 |
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Provider Enumeration Date | 11/14/2016 |
Last Update Date | 01/31/2025 |
Certification Date | 01/31/2025 |
Identifier | Type | State | Issuer |
---|---|---|---|
1023550613 | NPI | - | NPPES |
2076706 | Medicaid | WA |
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