Healthcare Provider Details

I. General information

NPI: 1548343122
Provider Name (Legal Business Name): LISA ALEXIUS PUJOL BOE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10620 NE 8TH ST BELLEVUE PAIN INSTITUTE
BELLEVUE WA
98004-4380
US

IV. Provider business mailing address

12507 NE BEL RED RD STE 103
BELLEVUE WA
98005-2500
US

V. Phone/Fax

Practice location:
  • Phone: 425-999-9633
  • Fax:
Mailing address:
  • Phone: 925-984-5946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA85353
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: