Healthcare Provider Details

I. General information

NPI: 1194820001
Provider Name (Legal Business Name): WASHINGTON STATE DEPARTMENT OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 02/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 NE 150TH ST
SHORELINE WA
98155-7224
US

IV. Provider business mailing address

PO BOX 47901
OLYMPIA WA
98504-7901
US

V. Phone/Fax

Practice location:
  • Phone: 206-418-5410
  • Fax: 206-418-5415
Mailing address:
  • Phone: 360-236-4503
  • Fax: 360-236-4500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. HARVEY A. PEREZ
Title or Position: ASST SECRETARY, FINANCIAL SERVICES
Credential:
Phone: 360-236-4503