MEDICARE: DR. FERNANDO DIEGO PROANO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083P0500X	Preventive Medicine/Occupational Environmental Medicine Physician	MD00018972	WA

General Provider Information

NPI Number	:	1750363214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FERNANDO DIEGO PROANO M.D.

Provider Business Mailing Address
First Line	:	10618 2ND AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98146-1560
Country	:	US
Telephone Number	:	206-294-4197
Fax Number	:	425-589-0531

Provider Business Practice Location Address
First Line	:	10618 2ND AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98146-1560
Country	:	US
Telephone Number	:	206-294-4197
Fax Number	:	425-589-0531

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	08/05/2019

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