Healthcare Provider Details

I. General information

NPI: 1275394397
Provider Name (Legal Business Name): MELBA MATHEWS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2024
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 CENTRAL AVE N
KENT WA
98032-2016
US

IV. Provider business mailing address

6000 SOUTHCENTER BLVD
TUKWILA WA
98188-7773
US

V. Phone/Fax

Practice location:
  • Phone: 209-901-2000
  • Fax:
Mailing address:
  • Phone: 209-091-2000
  • Fax: 206-901-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: