MEDICARE: DR. TINA MARIA HUSSEINI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	MD00036499	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174527782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TINA MARIA HUSSEINI MD

Provider Business Mailing Address
First Line	:	1610 BISHOP RD. SW
Second Line	:	SUITE 101
City	:	TUMWATER
State	:	WA
Zip	:	98512
Country	:	US
Telephone Number	:	360-754-3338
Fax Number	:	360-753-4861

Provider Business Practice Location Address
First Line	:	1610 BISHOP RD. SW
Second Line	:	SUITE 101
City	:	TUMWATER
State	:	WA
Zip	:	98512
Country	:	US
Telephone Number	:	360-754-3338
Fax Number	:	360-753-4861

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	04/22/2015

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