Provider Demographics
NPI:1275843740
Name:PUGET SOUND BLOOD CENTER
Entity Type:Organization
Organization Name:PUGET SOUND BLOOD CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VICENTE
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTANON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-448-5692
Mailing Address - Street 1:1626 N WILCOX AVE
Mailing Address - Street 2:STE 183
Mailing Address - City:HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90028
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:921 TERRY AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104
Practice Address - Country:US
Practice Address - Phone:818-448-5692
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA50D0661429291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory