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General NPI Number Information
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NPI Number | 1063878684
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Entity Type | Organization
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Legal Business Name | PRIMAVITA FAMILY MEDICINE
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Dates
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Enumeration Date | 01/12/2016
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Last Update Date | 01/12/2016
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Provider Practice Location Address
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Address Line | 15446 BEL RED RD STE B15
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City | REDMOND
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State | WA
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Zip | 98052-5507
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Country | US
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Telephone | 425-273-0741
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Fax | 844-218-1125
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Provider Business Mailing Address
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Address Line | 15446 BEL RED RD STE B15
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City | REDMOND
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State | WA
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Zip | 98052-5507
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Country | US
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Telephone | 425-273-0741
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Fax | 844-218-1125
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Authorized Official
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Title or Position | OWNER
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Name | MS. LORINA SHINSATO
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Credential | N.D., EAMP
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Telephone | 425-273-0741
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC60071802
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | NT60071822
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License Number State | WA
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