Healthcare Provider Details

I. General information

NPI: 1477626323
Provider Name (Legal Business Name): BAJDA VALENTINA WELTY MS, LAC, LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 05/21/2020
Certification Date: 05/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9431 COPPERTOP LOOP NE UNIT 206
BAINBRIDGE ISLAND WA
98110
US

IV. Provider business mailing address

PO BOX 10578
BAINBRIDGE ISLAND WA
98110-0578
US

V. Phone/Fax

Practice location:
  • Phone: 206-780-6988
  • Fax: 206-686-3385
Mailing address:
  • Phone: 206-780-6988
  • Fax: 206-686-3385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1905
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60261321
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: