Healthcare Provider Details

I. General information

NPI: 1982138780
Provider Name (Legal Business Name): VALOR HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2017
Last Update Date: 04/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12360 LAKE CITY WAY NE
SEATTLE WA
98125-5447
US

IV. Provider business mailing address

12360 LAKE CITY WAY NE
SEATTLE WA
98125-5447
US

V. Phone/Fax

Practice location:
  • Phone: 206-384-4382
  • Fax: 206-440-3137
Mailing address:
  • Phone: 206-384-4382
  • Fax: 206-440-3137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberLW6016081
License Number StateWA

VIII. Authorized Official

Name: MS. JESSICA WALCOTT
Title or Position: CLINIC OPERATIONS DIRECTOR
Credential:
Phone: 206-384-4382