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General NPI Number Information
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NPI Number | 1679068852
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Entity Type | Individual
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Provider Name | ISSACHAR NISTRIAN CRST
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Gender | Male
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Dates
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Enumeration Date | 06/28/2018
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Last Update Date | 06/28/2018
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Provider Practice Location Address
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Address Line | 3626 FACTORIA BLVD SE
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City | BELLEVUE
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State | WA
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Zip | 98006-6128
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Country | US
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Telephone | 310-409-4277
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Fax |
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Provider Business Mailing Address
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Address Line | 5603 ELAINE AVE SE
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City | AUBURN
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State | WA
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Zip | 98092-8399
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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 |
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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 | 156F00000X
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Taxonomy Name | Technician/Technologist
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License Number | 60736793
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License Number State | WA
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