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General NPI Number Information
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NPI Number | 1457946758
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Entity Type | Organization
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Legal Business Name | QUINAULT AVE LLC
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Dates
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Enumeration Date | 03/08/2021
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Last Update Date | 06/20/2025
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Provider Practice Location Address
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Address Line | 6700 FORT DENT WAY STE 200
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City | TUKWILA
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State | WA
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Zip | 98188-2504
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Country | US
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Telephone | 425-525-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 6700 FORT DENT WAY STE 200
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City | TUKWILA
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State | WA
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Zip | 98188-2504
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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 | ADMINISTRATOR
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Name | CHRISTIAN MONET
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Credential |
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Telephone | 509-374-3880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0132X
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Taxonomy Name | Ophthalmologic Surgery Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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