Healthcare Provider Details

I. General information

NPI: 1528599685
Provider Name (Legal Business Name): SOUTH SOUND VASECTOMY AND MEN'S HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 W BAY DR NW SUITE 105
OLYMPIA WA
98502-4926
US

IV. Provider business mailing address

324 W BAY DR NW SUITE 105
OLYMPIA WA
98502-4926
US

V. Phone/Fax

Practice location:
  • Phone: 360-742-3562
  • Fax: 360-915-7925
Mailing address:
  • Phone: 360-742-3562
  • Fax: 360-915-7925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD60017650
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY NEAL ZOLA
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 360-742-3562