Healthcare Provider Details

I. General information

NPI: 1740407436
Provider Name (Legal Business Name): ANDREA OPALENIK DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3423 13TH AVE W
SEATTLE WA
98119-1610
US

IV. Provider business mailing address

3423 13TH AVE W
SEATTLE WA
98119-1610
US

V. Phone/Fax

Practice location:
  • Phone: 310-990-5941
  • Fax: 206-787-9007
Mailing address:
  • Phone: 310-990-5941
  • Fax: 206-787-9007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number335384
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: