Healthcare Provider Details

I. General information

NPI: 1427443332
Provider Name (Legal Business Name): REBECCA OLUFADE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9600 VETERANS DR SW
TACOMA WA
98493-0001
US

IV. Provider business mailing address

9600 VETERANS DR SW
TACOMA WA
98493-0003
US

V. Phone/Fax

Practice location:
  • Phone: 253-582-8440
  • Fax:
Mailing address:
  • Phone: 253-583-1759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number263561
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD60931357
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License NumberMD60931357
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: