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General NPI Number Information
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NPI Number | 1801973219
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Entity Type | Individual
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Provider Name | TAJ MAHALIA ROCK PHYSICIAN ASSISTANT
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Gender | Female
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 12303 NE 130 LN #330 EVERGREEN DERMATOLOGY CENTER
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City | KIRKLAND
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State | WA
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Zip | 98034
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Country | US
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Telephone | 425-899-4300
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Fax | 425-899-4305
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Provider Business Mailing Address
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Address Line | 9710 5TH AVE NE #201
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City | SEATTLE
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State | WA
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Zip | 98115
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Country | US
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Telephone | 206-604-0160
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | MD00029104
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 3125
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License Number State | AK
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