Healthcare Provider Details

I. General information

NPI: 1730544677
Provider Name (Legal Business Name): ALFRED A GONIE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2015
Last Update Date: 12/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18416 38TH DR SE
BOTHELL WA
98012-8823
US

IV. Provider business mailing address

18416 38TH DR SE
BOTHELL WA
98012-8823
US

V. Phone/Fax

Practice location:
  • Phone: 425-877-8117
  • Fax: 425-424-0088
Mailing address:
  • Phone: 877-224-4884
  • Fax: 425-424-0088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WV0202X
TaxonomyVehicle Modifications Contractor
License Number
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: