=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306079793
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAFAT UNNISA M.D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2009
-----------------------------------------------------
Last Update Date | 11/06/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4011 TALBOT RD S SUITE 460
-----------------------------------------------------
City | RENTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98055-5773
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-271-5020
-----------------------------------------------------
Fax | 425-271-5382
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 59028
-----------------------------------------------------
City | RENTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98058-2028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-251-5110
-----------------------------------------------------
Fax | 425-793-7458
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | MD60122207
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------