Provider Demographics
NPI:1093070559
Name:PODGURECKI, CARLA
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:
Last Name:PODGURECKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34616 11TH PL S
Mailing Address - Street 2:STE 4
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-8705
Mailing Address - Country:US
Mailing Address - Phone:253-927-2150
Mailing Address - Fax:253-927-2851
Practice Address - Street 1:34616 11TH PL S
Practice Address - Street 2:STE 4
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8705
Practice Address - Country:US
Practice Address - Phone:253-927-2150
Practice Address - Fax:253-927-2851
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60572503207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8946546Medicare PIN