Provider Demographics
NPI:1003946914
Name:HILLTOP MEDICAL CLINIC PS
Entity Type:Organization
Organization Name:HILLTOP MEDICAL CLINIC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KHAIRUNNISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJWANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-951-7081
Mailing Address - Street 1:2418 SE 2ND PL
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-8876
Mailing Address - Country:US
Mailing Address - Phone:425-430-2704
Mailing Address - Fax:
Practice Address - Street 1:18802 MT VIEW DR
Practice Address - Street 2:18802 MT VIEW
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98390-8391
Practice Address - Country:US
Practice Address - Phone:253-447-4737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00041861261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care