Healthcare Provider Details

I. General information

NPI: 1225641152
Provider Name (Legal Business Name): MARINA PARK PLASTICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2020
Last Update Date: 08/29/2020
Certification Date: 08/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 CENTRAL WAY
KIRKLAND WA
98033-6115
US

IV. Provider business mailing address

16 CENTRAL WAY
KIRKLAND WA
98033-6115
US

V. Phone/Fax

Practice location:
  • Phone: 425-655-1200
  • Fax:
Mailing address:
  • Phone: 425-655-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ZACHARY P JOOS
Title or Position: OWNER
Credential: MD
Phone: 425-655-1200