=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386746220
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NALINI TULSIDAS VASSA M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2006
-----------------------------------------------------
Last Update Date | 03/21/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 510 N COLORADO ST SUITE A
-----------------------------------------------------
City | KENNEWICK
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99336-7770
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-735-6689
-----------------------------------------------------
Fax | 509-735-6998
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8514 W GAGE BLVD STE G
-----------------------------------------------------
City | KENNEWICK
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99336-8108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-222-1275
-----------------------------------------------------
Fax | 509-491-3031
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | MD00044334
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number | MD00044334
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------