Healthcare Provider Details

I. General information

NPI: 1447981766
Provider Name (Legal Business Name): PETER TZONEV CBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2022
Last Update Date: 06/17/2022
Certification Date: 06/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 S PINE ST STE 505
TACOMA WA
98409-7208
US

IV. Provider business mailing address

4301 S PINE ST STE 505
TACOMA WA
98409-7208
US

V. Phone/Fax

Practice location:
  • Phone: 253-292-4354
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberCB61155158
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: