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General NPI Number Information
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NPI Number | 1619188869
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Entity Type | Organization
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Legal Business Name | THE STELLA CENTER FOR FACIAL PLASTIC SURGERY
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Dates
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Enumeration Date | 05/26/2007
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 509 OLIVE WAY #1430
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City | SEATTLE
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State | WA
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Zip | 98101-1720
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Country | US
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Telephone | 206-682-3223
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Fax | 206-682-3224
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Provider Business Mailing Address
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Address Line | 509 OLIVE WAY #1430
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City | SEATTLE
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State | WA
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Zip | 98101-1720
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Country | US
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Telephone | 206-682-3223
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Fax | 206-682-3224
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Authorized Official
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Title or Position | OWNER
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Name | STELLA DESYATNIKOVA
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Credential | MD
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Telephone | 206-682-3223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 602302730
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License Number State | WA
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