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General NPI Number Information
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NPI Number | 1841567021
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Entity Type | Organization
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Legal Business Name | SOUTH SOUND MEDICAL CLINIC INC
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Dates
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Enumeration Date | 11/16/2011
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Last Update Date | 11/16/2011
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Provider Practice Location Address
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Address Line | 820 6TH AVE SUITE B
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City | TACOMA
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State | WA
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Zip | 98405-5210
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Country | US
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Telephone | 253-474-7336
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Fax |
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Provider Business Mailing Address
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Address Line | 11012 CANYON RD E STE #8 PMB 779
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City | PUYALLUP
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State | WA
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Zip | 98373-4200
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Country | US
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Telephone | 253-474-7336
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DANIEL M PELUSO
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Credential |
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Telephone | 253-474-7336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number |
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License Number State |
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