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General NPI Number Information
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NPI Number | 1457521619
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Entity Type | Organization
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Legal Business Name | RUSSELL W FARIA DO PC
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Dates
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Enumeration Date | 03/04/2008
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Last Update Date | 03/04/2008
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Provider Practice Location Address
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Address Line | 15215 SE 272ND ST STE 103
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City | KENT
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State | WA
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Zip | 98042-4215
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Country | US
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Telephone | 253-639-1883
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Fax | 253-639-1891
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Provider Business Mailing Address
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Address Line | 15215 SE 272ND ST STE 103
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City | KENT
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State | WA
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Zip | 98042-4215
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Country | US
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Telephone | 253-639-1883
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Fax | 253-639-1891
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Authorized Official
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Title or Position | BILLING MGR
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Name | MS. TRISH BUKAUSKAS
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Credential |
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Telephone | 843-293-9966
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | D020354
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License Number State | OR
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