=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003946914
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HILLTOP MEDICAL CLINIC PS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18802 MT VIEW DR 18802 MT VIEW
-----------------------------------------------------
City | BONNEY LAKE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98390-8391
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-447-4737
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2418 SE 2ND PL
-----------------------------------------------------
City | RENTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98056-8876
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-430-2704
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. KHAIRUNNISSA RAJWANI
-----------------------------------------------------
Credential | M.D
-----------------------------------------------------
Telephone | 253-951-7081
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | MD00041861
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------