Healthcare Provider Details

I. General information

NPI: 1598713273
Provider Name (Legal Business Name): SOUND MEDICAL IMAGING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12615 MERIDIAN EAST, STE 3
PUYALLUP WA
98373-3426
US

IV. Provider business mailing address

PO BOX 731301
PUYALLUP WA
98373-3426
US

V. Phone/Fax

Practice location:
  • Phone: 253-435-5195
  • Fax:
Mailing address:
  • Phone: 253-435-5195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD00044456
License Number StateWA

VIII. Authorized Official

Name: ALEXANDER SERRA
Title or Position: OWNER
Credential: MD
Phone: 253-435-5195