Healthcare Provider Details

I. General information

NPI: 1447370366
Provider Name (Legal Business Name): PABLO R PROANO MD PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 MADISON ST STE 1210
SEATTLE WA
98104-3586
US

IV. Provider business mailing address

17719 PAC AVE S VALLEY WEST BILLING SVC PMB 431
SPANAWAY WA
98387-8334
US

V. Phone/Fax

Practice location:
  • Phone: 206-386-3103
  • Fax: 206-386-3123
Mailing address:
  • Phone: 253-847-9195
  • Fax: 253-847-9292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20243
License Number StateWA

VIII. Authorized Official

Name: DR. PABLO R PROANO
Title or Position: MD CORPORATE PRESIDENT
Credential: MD
Phone: 206-386-3103