Healthcare Provider Details

I. General information

NPI: 1154398006
Provider Name (Legal Business Name): DANIEL G CUADRADO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 JACKSON AVE
TACOMA WA
98431-1000
US

IV. Provider business mailing address

3125 38TH AVE NW
GIG HARBOR WA
98335-8537
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-2200
  • Fax: 253-968-6234
Mailing address:
  • Phone: 615-293-1078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number22849
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number22849
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: