Provider Demographics
NPI:1225641152
Name:MARINA PARK PLASTICS, PLLC
Entity Type:Organization
Organization Name:MARINA PARK PLASTICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:P
Authorized Official - Last Name:JOOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-655-1200
Mailing Address - Street 1:16 CENTRAL WAY
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-6115
Mailing Address - Country:US
Mailing Address - Phone:425-655-1200
Mailing Address - Fax:
Practice Address - Street 1:16 CENTRAL WAY
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-6115
Practice Address - Country:US
Practice Address - Phone:425-655-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-29
Last Update Date:2020-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1476308Medicaid