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General NPI Number Information
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NPI Number | 1639109036
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Entity Type | Individual
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Provider Name | PABLO R PROANO M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | NORDSTROM MEDICAL TOWER 1229 MADISON ST. STE.#1210
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City | SEATTLE
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State | WA
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Zip | 98104
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Country | US
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Telephone | 253-847-9195
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Fax | 253-847-9292
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Provider Business Mailing Address
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Address Line | C/O VALLEY WEST BEHAVIORAL HEALTH BILLING SVC 17719 PACIFIC AVE S. PMB #431
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City | SPANAWAY
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State | WA
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Zip | 98387-8334
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Country | US
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Telephone | 253-847-9195
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Fax | 253-847-9292
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 20243
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License Number State | WA
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