Healthcare Provider Details

I. General information

NPI: 1609757863
Provider Name (Legal Business Name): SOLOMON TESSEGA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2025
Last Update Date: 09/11/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 PACIFIC AVE STE 600
TACOMA WA
98402-4437
US

IV. Provider business mailing address

14044 28TH AVE S
SEATAC WA
98168-3825
US

V. Phone/Fax

Practice location:
  • Phone: 125-384-4432
  • Fax:
Mailing address:
  • Phone: 206-786-8894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberML70043923
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: