Healthcare Provider Details

I. General information

NPI: 1912048745
Provider Name (Legal Business Name): ALLERGY & ASTHMA CENTER OF SW WASHINGTON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406 SE 164TH AVE STE 250
VANCOUVER WA
98683-9663
US

IV. Provider business mailing address

43575 MISSION BLVD # 716
FREMONT CA
94539-5831
US

V. Phone/Fax

Practice location:
  • Phone: 360-940-0810
  • Fax: 360-567-1967
Mailing address:
  • Phone: 360-609-7077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAJEEV JAIN
Title or Position: COO
Credential:
Phone: 408-476-0624