Provider Demographics
NPI:1124045034
Name:PATTIS, PALOMA (LAC)
Entity Type:Individual
Prefix:
First Name:PALOMA
Middle Name:
Last Name:PATTIS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1119
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-1119
Mailing Address - Country:US
Mailing Address - Phone:425-771-0184
Mailing Address - Fax:
Practice Address - Street 1:8000 212TH ST SW
Practice Address - Street 2:STE E
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7451
Practice Address - Country:US
Practice Address - Phone:425-776-6930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00000175171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPA3907OtherREGENCE