Provider Demographics
NPI:1508006594
Name:PAGADUAN, RENA (LMP)
Entity Type:Individual
Prefix:
First Name:RENA
Middle Name:
Last Name:PAGADUAN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11117 149TH AVE N
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98329-5447
Mailing Address - Country:US
Mailing Address - Phone:253-820-0398
Mailing Address - Fax:
Practice Address - Street 1:8912 KEY PENINSULA HWY N UNIT 3
Practice Address - Street 2:
Practice Address - City:LAKEBAY
Practice Address - State:WA
Practice Address - Zip Code:98349-8522
Practice Address - Country:US
Practice Address - Phone:253-820-0398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00010097225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist