Healthcare Provider Details

I. General information

NPI: 1275608648
Provider Name (Legal Business Name): NORTHWEST ASTHMA & ALLERGY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 04/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10333 19TH AVE SE #105
EVERETT WA
98208-4267
US

IV. Provider business mailing address

4540 SAND POINT WAY NE SUITE 200
SEATTLE WA
98105-3941
US

V. Phone/Fax

Practice location:
  • Phone: 425-385-2802
  • Fax: 425-337-7967
Mailing address:
  • Phone: 206-527-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA S. MATHIAS
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 206-527-2577