| NPI | 1366657918 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OVIDIO PENALVER Corporate Officer, Provider 253-848-0351 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD00015660) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA LH60394287) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: WA AP60312846) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP60311598) | |
| 103T00000X Psychologist (Licence: WA PY60385056) | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2015-12-23 |