Healthcare Provider Details

I. General information

NPI: 1013728344
Provider Name (Legal Business Name): ALLEGRA BLOMENBERG PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2025
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6002 WESTGATE BLVD STE 150
TACOMA WA
98406-2571
US

IV. Provider business mailing address

6002 WESTGATE BLVD STE 150
TACOMA WA
98406-2571
US

V. Phone/Fax

Practice location:
  • Phone: 253-752-8882
  • Fax: 253-752-8907
Mailing address:
  • Phone: 253-752-8882
  • Fax: 253-752-8907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61657251
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA61657251
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA61657251
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: