Healthcare Provider Details

I. General information

NPI: 1720696768
Provider Name (Legal Business Name): TRACE MENDLER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2020
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4311 11TH AVE NE STE 200
SEATTLE WA
98105-6367
US

IV. Provider business mailing address

3616 HARTZEL DR
SPRING VALLEY CA
91977-2017
US

V. Phone/Fax

Practice location:
  • Phone: 206-616-4001
  • Fax:
Mailing address:
  • Phone: 619-944-7012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number14157
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA66930
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61106151
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number14157
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: