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General NPI Number Information
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NPI Number | 1992486906
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Entity Type | Organization
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Legal Business Name | WASHINGTON PAIN AND SPINE SPECIALISTS LLC
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Dates
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Enumeration Date | 07/31/2023
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Last Update Date | 07/31/2023
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Provider Practice Location Address
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Address Line | 3525 ENSIGN RD NE STE J
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City | OLYMPIA
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State | WA
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Zip | 98506-5065
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Country | US
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Telephone | 240-463-4101
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Fax |
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Provider Business Mailing Address
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Address Line | 4957 LAKEMONT BLVD SE STE C-425
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City | BELLEVUE
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State | WA
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Zip | 98006-7801
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Country | US
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Telephone | 240-463-4101
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PRAVEEN KUMAR MAMBALAM
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Credential | MD
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Telephone | 240-463-4101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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