Healthcare Provider Details

I. General information

NPI: 1366581423
Provider Name (Legal Business Name): RICARDO T USI P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 MARTIN LUTHER KING JR WAY S STE 102
SEATTLE WA
98118-3589
US

IV. Provider business mailing address

14027 35TH AVE S
TUKWILA WA
98168-4009
US

V. Phone/Fax

Practice location:
  • Phone: 206-722-0534
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10001835
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: