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General NPI Number Information
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NPI Number | 1447370366
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Entity Type | Organization
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Legal Business Name | PABLO R PROANO MD PS
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1229 MADISON ST STE 1210
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City | SEATTLE
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State | WA
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Zip | 98104-3586
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Country | US
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Telephone | 206-386-3103
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Fax | 206-386-3123
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Provider Business Mailing Address
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Address Line | 17719 PAC AVE S VALLEY WEST BILLING SVC PMB 431
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City | SPANAWAY
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State | WA
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Zip | 98387-8334
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Country | US
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Telephone | 253-847-9195
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Fax | 253-847-9292
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Authorized Official
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Title or Position | MD CORPORATE PRESIDENT
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Name | DR. PABLO R PROANO
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Credential | MD
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Telephone | 206-386-3103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 20243
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License Number State | WA
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