Healthcare Provider Details

I. General information

NPI: 1205862323
Provider Name (Legal Business Name): LYNN FIORETTI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10510 GRAVELLY LAKE DRIVE
LAKEWOOD WA
98499
US

IV. Provider business mailing address

101 E 26TH STREET
TACOMA WA
98421-1108
US

V. Phone/Fax

Practice location:
  • Phone: 253-589-7030
  • Fax: 253-589-7033
Mailing address:
  • Phone: 253-722-1540
  • Fax: 253-722-1546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP00001516
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: