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General NPI Number Information
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NPI Number | 1396044947
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Entity Type | Organization
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Legal Business Name | MIND YOUR BODY CLINIC PLLC
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Dates
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Enumeration Date | 03/22/2011
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Last Update Date | 03/22/2011
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Provider Practice Location Address
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Address Line | 6900 E GREENLAKE WAY N SUITE J
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City | SEATTLE
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State | WA
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Zip | 98103
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Country | US
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Telephone | 206-957-7246
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 97115
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City | LAKEWOOD
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State | WA
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Zip | 98497-0115
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | DR. RAJNINDER JUTLA
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Credential | MD
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Telephone | 206-957-7246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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