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General NPI Number Information
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NPI Number | 1598222564
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Entity Type | Organization
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Legal Business Name | EASTSIDE TMS X WELLNESS CENTER
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Dates
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Enumeration Date | 02/26/2019
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Last Update Date | 02/26/2019
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Provider Practice Location Address
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Address Line | 15 S GRADY WAY STE 625
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City | RENTON
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State | WA
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Zip | 98057-3281
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Country | US
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Telephone | 425-891-3293
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Fax | 425-329-8087
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Provider Business Mailing Address
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Address Line | 15 S GRADY WAY STE 625
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City | RENTON
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State | WA
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Zip | 98057-3281
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Country | US
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Telephone | 425-891-3293
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Fax | 425-329-8087
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Authorized Official
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Title or Position | MANAGER
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Name | ARINOLA FATIMAT DADA
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Credential | MD
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Telephone | 425-891-3293
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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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 | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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