| |
9650 15th Ave Sw Ste 100 Seattle WA 98106-2576 | |
(206) 965-1055 | |
(206) 965-1032 |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 9650 15th Ave Sw Ste 100, 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 |
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Po Box 34703 Seattle WA 98124-1703 Ph: () - | 9650 15th Ave Sw Ste 100 Seattle WA 98106-2576 Ph: (206) 965-1055 |
NPI Number | 1265950521 |
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Provider Enumeration Date | 09/06/2017 |
Last Update Date | 01/31/2025 |
Identifier | Type | State | Issuer |
---|---|---|---|
1265950521 | NPI | - | NPPES |
2102223 | Medicaid | WA |
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