Healthcare Provider Details

I. General information

NPI: 1194392068
Provider Name (Legal Business Name): SB MEDICAL PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4310 COLBY AVE STE 202
EVERETT WA
98203-2338
US

IV. Provider business mailing address

4310 COLBY AVE STE 202
EVERETT WA
98203-2338
US

V. Phone/Fax

Practice location:
  • Phone: 425-293-0107
  • Fax: 425-293-0329
Mailing address:
  • Phone: 425-293-0107
  • Fax: 425-293-0329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name: RIDDHI BLOW
Title or Position: PRESIDENT
Credential: ND
Phone: 425-293-0107