Healthcare Provider Details

I. General information

NPI: 1013542885
Provider Name (Legal Business Name): RAFFY JATAMOSA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2020
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 LILLY RD NE
OLYMPIA WA
98506-5133
US

IV. Provider business mailing address

413 LILLY RD NE
OLYMPIA WA
98506-5133
US

V. Phone/Fax

Practice location:
  • Phone: 360-491-9480
  • Fax:
Mailing address:
  • Phone: 360-491-9480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1013542885
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: