Healthcare Provider Details

I. General information

NPI: 1346567666
Provider Name (Legal Business Name): PB PRIMARY CARE CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2010
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34617 11TH PL S STE 204
FEDERAL WAY WA
98003-8706
US

IV. Provider business mailing address

34617 11TH PL S STE 204
FEDERAL WAY WA
98003-8706
US

V. Phone/Fax

Practice location:
  • Phone: 253-874-8445
  • Fax: 253-874-2085
Mailing address:
  • Phone: 253-874-8445
  • Fax: 253-874-2085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PHILIP BUENVENIDA
Title or Position: OWNER
Credential:
Phone: 253-874-8445