Provider Demographics
NPI:1518978329
Name:FYNTRILAKIS, ANASTASIA (MD)
Entity Type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:
Last Name:FYNTRILAKIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 YAKIMA AVE
Mailing Address - Street 2:STE 110
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-5307
Mailing Address - Country:US
Mailing Address - Phone:253-627-9151
Mailing Address - Fax:253-591-8892
Practice Address - Street 1:1708 YAKIMA AVE
Practice Address - Street 2:STE 110
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-5307
Practice Address - Country:US
Practice Address - Phone:253-627-9151
Practice Address - Fax:253-591-8892
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00038302207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA080188806OtherRAILROAD
WA0162460OtherL & I
WA8323842Medicaid
WA8937111OtherCRIME VICTIMS
WA0162460OtherL & I
AB29675Medicare ID - Type Unspecified
WAGAB29675Medicare PIN