Healthcare Provider Details

I. General information

NPI: 1619756350
Provider Name (Legal Business Name): MARINA PARK PLASTICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2023
Last Update Date: 09/22/2023
Certification Date: 09/22/2023
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: 425-655-1987
Mailing address:
  • Phone: 425-655-1200
  • Fax: 425-655-1987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EILEEN FAY WEST
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 425-655-1200