Healthcare Provider Details

I. General information

NPI: 1457946758
Provider Name (Legal Business Name): QUINAULT AVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 FORT DENT WAY STE 200
TUKWILA WA
98188-2504
US

IV. Provider business mailing address

6700 FORT DENT WAY STE 200
TUKWILA WA
98188-2504
US

V. Phone/Fax

Practice location:
  • Phone: 425-525-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTIAN MONET
Title or Position: ADMINISTRATOR
Credential:
Phone: 509-374-3880