| NPI | 1306644190 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA FALL Payer Enrollment Manager 253-682-6040 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2025-03-06 |
| Last Update Date | 2025-03-06 |