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General NPI Number Information
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NPI Number | 1477296143
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Entity Type | Individual
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Provider Name | NICOLE JAVIER DELOS SANTOS MD
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Gender | Female
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Dates
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Enumeration Date | 04/19/2022
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 1202 MARTIN LUTHER KING JR WAY
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City | TACOMA
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State | WA
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Zip | 98405-3926
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Country | US
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Telephone | 253-441-4742
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Fax | 253-442-8790
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Provider Business Mailing Address
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Address Line | 1007 39TH AVE SE
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City | PUYALLUP
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State | WA
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Zip | 98374-2192
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Country | US
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Telephone | 877-828-4510
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Fax | 844-660-0690
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | MD70013534
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License Number State | WA
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