Healthcare Provider Details

I. General information

NPI: 1417634833
Provider Name (Legal Business Name): SEBASTIAN ALEJANDRO RAMOS SEGUEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33431 13TH PL S
FEDERAL WAY WA
98003-6357
US

IV. Provider business mailing address

955 POWELL AVE SW
RENTON WA
98057-2908
US

V. Phone/Fax

Practice location:
  • Phone: 253-874-7634
  • Fax: 253-874-7635
Mailing address:
  • Phone: 425-277-1311
  • Fax: 425-277-1566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A23974
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP70126781
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: