Provider Demographics
NPI:1518264407
Name:PATRICIA FANTONI-SALVADOR, PH.D., LLC.
Entity Type:Organization
Organization Name:PATRICIA FANTONI-SALVADOR, PH.D., LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FANTONI-SALVADOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-257-1061
Mailing Address - Street 1:10002 AURORA AVE N STE 36
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-9348
Mailing Address - Country:US
Mailing Address - Phone:206-257-1061
Mailing Address - Fax:206-257-1061
Practice Address - Street 1:10740 MERIDIAN AVE N STE 110
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-9010
Practice Address - Country:US
Practice Address - Phone:206-257-1061
Practice Address - Fax:206-257-1061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-11
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY 60199015251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE6645AMedicare PIN