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12812 101st Avenue Ct E Ste 202 Puyallup WA 98373-9103 | |
| (253) 864-4770 | |
| (253) 864-4771 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 12812 101st Avenue Ct E Ste 202, Puyallup, 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: () - | 12812 101st Avenue Ct E Ste 202 Puyallup WA 98373-9103 Ph: (253) 864-4770 |
| NPI Number | 1043407182 |
|---|---|
| Provider Enumeration Date | 10/03/2007 |
| Last Update Date | 02/03/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043407182 | NPI | - | NPPES |
| 2000111 | Medicaid | WA |
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