Healthcare Provider Details

I. General information

NPI: 1497318588
Provider Name (Legal Business Name): STEPHANIE SOBREPERA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE NGUYEN MD

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RADIOLOGY DEPARTMENT RR 210 1959 NE PACIFIC STREET
SEATTLE WA
98195-3450
US

IV. Provider business mailing address

PO BOX 5371 818 RC
SEATTLE WA
98145-5005
US

V. Phone/Fax

Practice location:
  • Phone: 206-598-6483
  • Fax:
Mailing address:
  • Phone: 206-987-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberMD.MD.70016458
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberML61059938
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: