=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760721898
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SALUTOGENICS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2013
-----------------------------------------------------
Last Update Date | 02/08/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 710 N 160TH ST B214
-----------------------------------------------------
City | SHORELINE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98133-5685
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-808-6736
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 710 N 160TH ST B214
-----------------------------------------------------
City | SHORELINE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98133-5685
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-808-6736
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NATUROPATHIC PHYSICIAN
-----------------------------------------------------
Name | DR. MASA SASAGAWA
-----------------------------------------------------
Credential | ND
-----------------------------------------------------
Telephone | 801-808-6736
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | NT1279
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------