| NPI | 1790357234 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LETRIANA SANTIAGO Credentialing Supervisor 206-764-0526 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty |
| Enumeration Date | 2021-07-14 |
| Last Update Date | 2021-07-14 |