Healthcare Provider Details

I. General information

NPI: 1407854953
Provider Name (Legal Business Name): SNOHOMISH COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 RUCKER AVE
EVERETT WA
98201
US

IV. Provider business mailing address

3020 RUCKER AVE SUITE 300
EVERETT WA
98201
US

V. Phone/Fax

Practice location:
  • Phone: 425-339-8711
  • Fax: 425-339-5216
Mailing address:
  • Phone: 425-339-8711
  • Fax: 425-339-5216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License NumberMD00023980
License Number StateWA

VIII. Authorized Official

Name: MRS. PAMELA AGUILAR
Title or Position: DEPARTMENT DEPUTY DIRECTOR
Credential:
Phone: 425-339-8690