Provider Demographics
NPI:1275042087
Name:NORTH TACOMA PEDIATRICS, INC
Entity Type:Organization
Organization Name:NORTH TACOMA PEDIATRICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:ORIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-267-5569
Mailing Address - Street 1:6002 WESTGATE BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-2571
Mailing Address - Country:US
Mailing Address - Phone:253-267-5569
Mailing Address - Fax:253-267-5295
Practice Address - Street 1:6002 WESTGATE BLVD STE 150
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-2571
Practice Address - Country:US
Practice Address - Phone:425-358-0290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-25
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00038849208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty