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General NPI Number Information
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NPI Number | 1063628576
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Entity Type | Organization
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Legal Business Name | VALLEY CHILDREN'S CLINIC
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4011 TALBOT RD S STE 220
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City | RENTON
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State | WA
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Zip | 98055-5791
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Country | US
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Telephone | 425-656-5300
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Fax |
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Provider Business Mailing Address
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Address Line | 4011 TALBOT RD S STE 220
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City | RENTON
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State | WA
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Zip | 98055-5791
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Country | US
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Telephone | 425-656-5300
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Fax |
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Authorized Official
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Title or Position | CLINIC ADMINISTRATOR
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Name | KATHY MCBRIDE
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Credential |
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Telephone | 425-656-5350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number |
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License Number State |
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