Healthcare Provider Details

I. General information

NPI: 1528996659
Provider Name (Legal Business Name): LIFEBORA HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 19TH ST
EVERETT WA
98201-1823
US

IV. Provider business mailing address

522 W RIVERSIDE AVE STE N
SPOKANE WA
99201-0581
US

V. Phone/Fax

Practice location:
  • Phone: 425-479-5555
  • Fax:
Mailing address:
  • Phone: 425-273-1990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JULIET KIMATHI
Title or Position: DIRECTOR
Credential: MD
Phone: 425-273-1990