Healthcare Provider Details

I. General information

NPI: 1568856490
Provider Name (Legal Business Name): REBECCA EMMA VIRATA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2015
Last Update Date: 10/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 5TH AVE # P100
SEATTLE WA
98104
US

IV. Provider business mailing address

800 5TH AVE # P100
SEATTLE WA
98104-3176
US

V. Phone/Fax

Practice location:
  • Phone: 206-320-3351
  • Fax: 206-554-7787
Mailing address:
  • Phone: 206-320-3351
  • Fax: 206-554-7787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD60957546
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: