Healthcare Provider Details

I. General information

NPI: 1548523756
Provider Name (Legal Business Name): LISA DAWN PAMINTUAN CPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 06/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21540 30TH DR SE STE 220
BOTHELL WA
98021-7015
US

IV. Provider business mailing address

21540 30TH DR SE STE 220
BOTHELL WA
98021-7015
US

V. Phone/Fax

Practice location:
  • Phone: 206-341-0646
  • Fax:
Mailing address:
  • Phone: 206-341-0646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA00047618
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: