Healthcare Provider Details

I. General information

NPI: 1013664564
Provider Name (Legal Business Name): SOUND PAIN ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2022
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13033 NE BEL RED RD STE 120
BELLEVUE WA
98005-2633
US

IV. Provider business mailing address

13033 NE BEL RED RD STE 120
BELLEVUE WA
98005-2633
US

V. Phone/Fax

Practice location:
  • Phone: 425-440-3351
  • Fax: 425-440-3439
Mailing address:
  • Phone: 425-440-3351
  • Fax: 425-440-3439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSH LEDER
Title or Position: ADMINISTRATOR
Credential:
Phone: 801-641-5613