Healthcare Provider Details

I. General information

NPI: 1548779895
Provider Name (Legal Business Name): PROFESSIONAL ADMINISTRATIVE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2017
Last Update Date: 10/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S CHERRY ST
BURLINGTON WA
98233-1810
US

IV. Provider business mailing address

PO BOX 1534
BURLINGTON WA
98233-0619
US

V. Phone/Fax

Practice location:
  • Phone: 360-391-4393
  • Fax: 360-391-4393
Mailing address:
  • Phone: 360-391-4393
  • Fax: 360-422-5299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number0363797
License Number StateWA

VIII. Authorized Official

Name: LILIANA IBARRA
Title or Position: OWNER
Credential:
Phone: 360-391-4393