Healthcare Provider Details

I. General information

NPI: 1275854887
Provider Name (Legal Business Name): SOUND VASCULAR, P.S
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2010
Last Update Date: 04/20/2020
Certification Date: 04/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32014 32ND AVE S
FEDERAL WAY WA
98001-9625
US

IV. Provider business mailing address

32014 32ND AVE S
FEDERAL WAY WA
98001-9625
US

V. Phone/Fax

Practice location:
  • Phone: 253-874-7107
  • Fax: 253-874-1923
Mailing address:
  • Phone: 253-874-7107
  • Fax: 253-874-1923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246XC2903X
TaxonomyVascular Specialist/Technologist Cardiovascular
License Number602991235
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2471C1101X
TaxonomyCardiovascular-Interventional Technology Radiologic Technologist
License Number602991235
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number602991235
License Number StateWA

VIII. Authorized Official

Name: ALISON MORENO
Title or Position: ADMINISTRATOR
Credential:
Phone: 206-929-9695