Healthcare Provider Details

I. General information

NPI: 1215755343
Provider Name (Legal Business Name): ENZI WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2024
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 ANDOVER PARK W STE 200
TUKWILA WA
98188-3379
US

IV. Provider business mailing address

555 ANDOVER PARK W STE 200
TUKWILA WA
98188-3379
US

V. Phone/Fax

Practice location:
  • Phone: 206-593-6666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: AHMED H SALAD
Title or Position: CEO
Credential:
Phone: 206-593-6666