Healthcare Provider Details

I. General information

NPI: 1619137635
Provider Name (Legal Business Name): CAPITAL PEDIATRICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 04/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 CATON WAY SW
OLYMPIA WA
98502-1105
US

IV. Provider business mailing address

2112 CATON WAY SW
OLYMPIA WA
98502-1105
US

V. Phone/Fax

Practice location:
  • Phone: 360-754-1629
  • Fax: 360-754-1964
Mailing address:
  • Phone: 360-754-1629
  • Fax: 360-754-1964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: JANET NESS
Title or Position: OFFICE MANAGER
Credential:
Phone: 360-754-1629