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General NPI Number Information
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NPI Number | 1215382015
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Entity Type | Individual
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Provider Name | VITALIY P NATKHA DO
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Gender | Male
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Dates
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Enumeration Date | 04/28/2016
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 1802 YAKIMA AVE STE 104
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City | TACOMA
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State | WA
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Zip | 98405-5303
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Country | US
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Telephone | 253-426-6272
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Fax | 253-426-4060
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Provider Business Mailing Address
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Address Line | 1802 YAKIMA AVE STE 104
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City | TACOMA
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State | WA
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Zip | 98405-5303
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Country | US
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Telephone | 253-426-6272
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Fax | 253-426-4060
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 2023008400
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 2086S0127X
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Taxonomy Name | Trauma Surgery Physician
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License Number | OP61548249
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | OP61548249
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License Number State | WA
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