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General NPI Number Information
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NPI Number | 1346567666
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Entity Type | Organization
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Legal Business Name | PB PRIMARY CARE CLINIC LLC
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Dates
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Enumeration Date | 04/26/2010
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Last Update Date | 05/01/2024
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Provider Practice Location Address
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Address Line | 34617 11TH PL S STE 204
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City | FEDERAL WAY
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State | WA
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Zip | 98003-8706
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Country | US
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Telephone | 253-874-8445
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Fax | 253-874-2085
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Provider Business Mailing Address
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Address Line | 34617 11TH PL S STE 204
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City | FEDERAL WAY
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State | WA
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Zip | 98003-8706
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Country | US
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Telephone | 253-874-8445
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Fax | 253-874-2085
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Authorized Official
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Title or Position | OWNER
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Name | PHILIP BUENVENIDA
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Credential |
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Telephone | 253-874-8445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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