=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417603739
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | J E PARALES MEDICAL PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2022
-----------------------------------------------------
Last Update Date | 02/24/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3716 PACIFIC AVE STE D
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98418-7836
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-474-7719
-----------------------------------------------------
Fax | 253-471-8592
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4936 40TH ST NE
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98422-3028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-921-8109
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MARIA JELYN ENGELHARDT-PARALES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 253-921-8109
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------