Healthcare Provider Details

I. General information

NPI: 1396948956
Provider Name (Legal Business Name): PAUL A SUENO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 16TH AVE E
SEATTLE WA
98112-5211
US

IV. Provider business mailing address

125 16TH AVE E
SEATTLE WA
98112-5260
US

V. Phone/Fax

Practice location:
  • Phone: 206-326-3000
  • Fax: 206-326-2785
Mailing address:
  • Phone: 206-326-3000
  • Fax: 206-326-2785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberMD60252648
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD60252648
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: