Healthcare Provider Details

I. General information

NPI: 1306079793
Provider Name (Legal Business Name): RAFAT UNNISA M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2009
Last Update Date: 11/06/2021
Certification Date: 11/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4011 TALBOT RD S SUITE 460
RENTON WA
98055-5773
US

IV. Provider business mailing address

PO BOX 59028
RENTON WA
98058-2028
US

V. Phone/Fax

Practice location:
  • Phone: 425-271-5020
  • Fax: 425-271-5382
Mailing address:
  • Phone: 425-251-5110
  • Fax: 425-793-7458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD60122207
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: