Healthcare Provider Details

I. General information

NPI: 1437082013
Provider Name (Legal Business Name): WASHINGTON PAIN AND SPINE SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 NASSAU ST
EVERETT WA
98201-4140
US

IV. Provider business mailing address

4957 LAKEMONT BLVD SE STE C-425
BELLEVUE WA
98006-7801
US

V. Phone/Fax

Practice location:
  • Phone: 206-895-1825
  • Fax:
Mailing address:
  • Phone: 206-895-1825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: PRAVEEN KUMAR MAMBALAM
Title or Position: PRESIDENT
Credential:
Phone: 206-895-1825